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The Healthcare Penalties Are Coming!!

Posted on April 3, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

We all know about the Meaningful Use penalties. The PQRS penalties. The Value Based Modifier penalties. Individually, they’d all be annoying, but I don’t think most healthcare organizations have understood what these penalties will be in aggregate.

This hit home to me when I was reading a smartly titled post by Jim Tate called “What you don’t do in 2015 will cause 9% CMS penalties in 2017” Here’s how he describes the penalties that are in store for healthcare:

MU: Failing to achieve MU in 2014 will bring a 2% penalty beginning in 2016 with a 1% annual increase up to 5%.

Physician Quality Reporting System (PQRS): Non-participation brings a Medicare reimbursement reduction of 2.0% in 2016 based on 2014 data.

Value-Based Modifier(VBM): The VBM, which many providers are not aware of, is linked to PQRS. Beginning in 2016, eligible providers (EPs) in groups with 10 or more EPs will be subject to a penalty based on performance. In 2017, this will include all EPs, not just those in larger groups.

Taken together, this adds up to a 9% penalty in 2017 based on 2015 participation.
To avoid these penalties, immediately assess your current participation in the MU, PQRS, and VBM programs. If you are not on track you must take steps to mitigate your risk as soon as possible.

Risk mitigation is the right way to describe it. As I mentioned in the beginning, I don’t think that many providers are planning ahead to avoid these penalties. I also don’t think they realize the long term consequences of the choices they make today.

Thanks Jim for waking us up to the reality.

Are You A Sitting Duck for HIPAA Data Breaches? – Infographic

Posted on November 18, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The people at DataMotion, cloud based HISP providers, sent me the following infographic covering the HIPAA data breaches. It’s a good reminder of the potential for data breaches in healthcare. As Marc Probst recently suggested, we should be focusing as much attention on things like security as we are on meaningful use since the penalties for a HIPAA violation are more than the meaningful use penalties.

Are You A Sitting Duck for HIPAA Data Breaches Infographic

Meaningful Use Hardship Exceptions Reopened

Posted on October 8, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

CMS has announced its intent to reopen the Meaningful Use Hardship Exceptions filing period and set the new deadline for MU hardship exceptions to November 30, 2014. With the new hardship exception extension, providers can now choose from a number of reasons why they were unable to attest in time. Here’s the details from the CMS announcement:

This reopened hardship exception application submission period is for eligible professionals and eligible hospitals that:
* Have been unable to fully implement 2014 Edition CEHRT due to delays in 2014 Edition
CEHRT availability; AND
* Eligible professionals who were unable to attest by October 1, 2014 and eligible hospitals that were unable to attest by July 1, 2014 using the flexibility options provided in the CMS 2014 CEHRT Flexibility Rule.

These are the only circumstances that will be considered for this reopened hardship exception
application submission period.

This is a big move since the meaningful use hardship exceptions deadline for hospitals was April 1, 2014 and July 1, 2014 for eligible professionals. I imagine there are many organizations that will benefit from this extension. Although, there are probably quite a few organizations that wish they’d known about this exception before now or that think the exceptions are too narrow (ie. they can’t benefit from them).

What are your thoughts on this extension?

Hospital Must Pay Back $31 Million in Meaningful Use Money

Posted on November 7, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The news just came out that Health Management Associates, Inc. (“HMA”) did not meet the meaningful use requirements necessary to receive the EHR incentive money and so they’ll have to pay back all of the money they’ve been paid by CMS. Here’s a portion of the article that details the amount they have to pay back:

The Company estimates that, between July 1, 2011 and September 30, 2013, it recognized as income HCIT incentive payments totaling approximately $31.0 million for the hospitals that did not meet the “meaningful use” criteria. Of these payments, the Company recognized as income approximately $8.3 million in 2011, approximately $17.3 million in 2012 and approximately $5.4 million in the first six months of 2013. On October 30, 2013, the Company withdrew the 11 hospitals from the HCIT programs and has repaid the majority of the funds to CMS. The Company is in the process of repaying the balance of the funds to the relevant state programs. The Company expects to re-enroll the hospitals in the HCIT programs and may be able to recoup some portion of the amounts repaid.

$31 million is a lot of meaningful use money to pay back. I’m still waiting for the details of why they failed their meaningful use attestation to come out. Although, I believe I read that the top management at HMA are gone from the company as well. So, it’s hard to say if this was a simple meaningful use mistake or if it was an intentional effort to game the EHR incentive and meaningful use system. In meaningful use stage 1 this is particularly easy to game since it was self-attestation.

I’m sad to say that I wrote about the potential of having to payback EHR incentive money previously. Plus, as I mention in that article, HMA will now be subject to the EHR penalties as well if they don’t get things corrected before those go in place. Of course, in my post I discuss organizations that make a good faith effort to attest to meaningful use. We’ll see if HMA made a good faith effort or not. Either way, this is an important warning for those organizations that aren’t doing everything they can do meet the meaningful use guidelines.

One EHR expert I spoke with about this situation said, “It’s not the last of such announcements I expect to come out in the next few months.” I’d only modify that to say “in the next few years.” If organizations had problems with meaningful use stage 1, you can be sure the problems will be multiplied with MU stage 2 and 3.

The problem is that if too many more stories like this come out it’s going to take a program that was suppose to incentivize EHR and make it into a weight around the neck of EHR implementations.

How to Avoid Meaningful Use Penalties – Meaningful Use Monday

Posted on April 23, 2012 I Written By

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money.

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts.

When the EHR Incentive Program was first announced, many providers told me that while they might be willing to forego the potential incentive payments for meaningful use, they could never accept the 2015 penalties (AKA “adjustments”) for non-compliance. Back in 2009, 2015 seemed far in the future—but for those motivated by penalty avoidance, it’s time to make sure that meaningful use is within your grasp. 

The Proposed Rule for Meaningful Use Stage 2, (page 13771), defines the timeline for the assessment of penalties. The safest way to avoid the 2015 penalty is to successfully demonstrate meaningful use in 2013. (Yes, 2013—this is not a typo!) Failing that, a provider whose first year of participation is 2014 has until October 1, 2014 to successfully attest, which means that he/she must begin the 90-day reporting period no later than July 3 of that year. For future year penalties—that increase by 1% annually—the pattern would be the same: full calendar year reporting two years prior or 90-day reporting in the year prior to the penalty assessment.

Bottom line: You cannot wait until 2015 to be a meaningful user if you are concerned about the penalties. And if you haven’t embarked on the EHR adoption process yet, 2013 will sneak up on you very quickly!

Radiologists, Meaningful Use and EHR Incentive Money – Meaningful Use Monday

Posted on December 5, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I recently had someone ask me about radiology and whether they needed to comply with meaningful use and if they qualified for EHR incentive money. Good thing is that I found this Healthcare IT news article that discusses radiology and the EHR incentive money.

Let’s start off with a stat about whether radiologists qualify for the government EHR money.

An estimated 90% of radiologists are eligible for incentive payments from the CMS, according to the American College of Radiology.

I was surprised that the number of radiologists that qualify is so high. So, I guess the simple answer is that yes, almost all radiologists qualify for the EHR stimulus money. Yes, that also means that radiologists will also be subject to the penalties for not being meaningful users of an EHR system.

Although, I guess there has been confusion around whether radiologists qualify for the EHR money. This quote illustrates how widespread this could be:

“Most radiologists seem to believe that they weren’t included in the meaningful use regulations, but the opposite is true,” said Murray Reicher, M.D., DR Systems co-founder and chairman. “The real challenge is meeting the requirements in time to get the largest bonuses — and just as important, to avoid future penalties.”

With that out of the way, the next question is how hard it is for radiologists to meet the meaningful use requirements. I’d love to hear from some radiologists who have either been through the meaningful use stage 1 attestation process or who have looked through the requirements and can point out the meaningful use measures that will be hard for radiologists to achieve. I’m sure there are a number of them that they won’t need to show.

Either way, it’s worth noting that radiologists do qualify for the EHR stimulus money and also could be subject to the future EHR penalties. I wonder how many EHR software vendors work with radiologists.

The Low-Down on Future Meaningful Use Penalties — Meaningful Use Monday

Posted on November 28, 2011 I Written By

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money.

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts.

Meaningful Use penalties—or to use the politically correct word, “adjustments”—are scheduled to begin in 2015 for providers who are not meaningful users of certified EHR technology by 2014. There’s something about the prospect of incurring a revenue reduction that seems to evoke a visceral response among providers—even among those who do not find the potential incentive money motivating.

Here’s what you need to know about the penalties:

1) Penalties apply to Medicare only.
– Adjustments will be applied as a percent of Medicare Part B Professional Fee Schedule Charges.
– They are scheduled to begin in 2015, and continue as follows:
2015: 1%
2016: 2%
2017: 3%
2018 and 2019: may increase 1%/year, at the discretion of the Secretary of HHS.

2) There has been speculation by some industry pundits that the penalties will be delayed or not implemented at all, but to rely upon that as a given would be a mistake.

3) There are no penalties associated with the Medicaid program—adjustments do not apply to Medicaid revenue. Pursuing the EHR incentives as a Medicaid provider, however, does not totally insulate a physician from the penalties. If a Medicaid provider does not become a meaningful user by 2014, the revenue he/she generates under Medicare would be subject to the adjustments above.

Small EHR Vendor and Specialty EHR Vendor Rant

Posted on November 2, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The following was a comment made on my previous post about Meaningful Use attestation issues by Jon (man there are a lot of John/Jon’s in Health IT). As always, I do my best to bring out interesting topics for all to read. In this rant, Jon makes some interesting comments about the challenge of specialty EHR software to meet the MU measures. Something I’ve mentioned before, but Jon adds some more insight.

*start rant*

It is even worse for some small EHR vendors that have existed for over 20 years – like the one I work for. The government has no idea how ugly and not applicable many key elements of meaningful use (defined as the government chooses) are for non-primary care, highly specialized providers.

Here’s a conundrum that frames EHR certification and meaningful use in a way I rarely see it discussed (and would love for someone to explore more *hint hint*) – take a small, but established vendor of EHR software which is not yet certified.

This vendor provides software to a niche industry of highly specialized providers, who do not derive any real or identifiable value from meaningful use as it is defined (to keep things generic I will omit the specific part of the industry).

To get software 100% EHR certified you must fulfill all of the requirements, even if, as a vendor, your customers will not make use of, or benefit from, most of the functionality. Please take as an assumption (for this discussion) that only 30-40% of the EHR certification requirements are of value to the customer.

Since the customer will not make use of the functionality, they don’t want really want to pay for a 100% EHR certified product. But they sure would like the incentive money (or in the case of Medicare providers, will get penalized if they didn’t do meaningful use).

As a small vendor, your big competitors are all EHR certified (and some are even free), but even if it didn’t make sense for the customer – because the other (typically larger) vendor can afford to implement it, even if it is sloppy. Customers see a well-known product name from a large company is EHR certified – so EHR certification gives those who complete it an edge – even if it makes zero financial or functional sense.

I hate being a pessimist, as surely some good has come from meaningful use. However, as we are seeing by these posts, what value does EHR certification and meaningful use TRULY bring to the provider, other than the requisite piece of paper to get incentive money? We need to see many, many more successes, and in my specific case, we need to make sense of how to make something which is not useful… useful somehow.

Sure, the answer to this might be that in the long run, vendors with better or more applicable products will always win out, but we know that this isn’t always true based on long-term software contracts or lack of desire to switch vendors. Or the answer might be that highly specialized providers only account for 20% or less, and 80% of the provider population is primary care or similar handle meaningful use just fine. Or maybe that I’m just crying in my beer!

Nevertheless, we have this catch-22.. or an enigma wrapped in a mystery shrouded in a riddle.

*end rant* Comments? Thoughts?

One other note from John Lynn, I’m sure many large EHR vendors will probably say that if small EHR vendors can’t meet the MU requirements, then they don’t deserve to be an EHR software. Those that say this, are really missing the point. It’s not that they couldn’t meet the MU requirements, it’s a question of should they meet them in MU’s current state.