Proposed Changes in MU's Attestation Periods: Will They Drive Meaningful Change?

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By Michael Burger, Senior Consultant

How do you spell relief? The Centers for Medicare and Medicaid Services (CMS) apparently hopes that proposed changes in Meaningful Use (MU) attestation periods will give providers some of the breaks they have been seeking and drive up plummeting physician attestation rates.  Is this too little, too late, or will it drive meaningful change?

CMS recently announced it is considering several proposals to help providers garner MU incentive payments and avoid Medicare payment penalties. The proposals suggest that CMS is trying to address providers’ concerns that the 2014 criteria were basically unreachable and unworkable, not to mention the perception that MU itself is too unwieldy and burdensome.  

There are three suggested changes on the table:

  • Realignment of hospital reporting periods for MU stage 2 electronic health record (EHR) use to the calendar year. 
  • Modification of other aspects of the program to match long-term goals, reduce complexity, and lessen providers' reporting burdens.
  • Shorten the reporting period for ambulatory physician use of stage 2-certified EHRs in 2015 to 90 days, down from 365 days.

If adopted, what, if anything, will these changes accomplish?

Hospitals. The new calendar-year attestation period will help give eligible hospitals more time to install  2014 Edition software, incorporate it into their workflows, and get trained on how to use it. This obviously is helpful. However, the new attestation period is unlikely to drive significant changes in how hospitals purchase and use MU-certified EHRs.  That is because most hospitals have already made EHR- and MU-related decisions, and a change to the attestation period at this point isn’t likely to alter those decisions.

According to recently released CMS attestation data, 9 in 10 eligible hospitals had attested to MU use and were using MU-certified EHRs through December 2014.  Very few of those (10%) who had attested between 2011– 2013 dropped out of the MU program. CMS believes that some 4,000 hospitals are scheduled to attest to Meaningful Use Stage 2 in FY 2015 and of those, the vast majority were using 2014 certified technology in FY 2014.

While there is always room for improvement, hospitals seem to be pretty much set for MU adoption and use in 2015.

Ambulatory physicians.  Ambulatory physicians are a whole different story. About three-quarters of eligible professionals (EPs) were unable to attest for 2014. Moreover, roughly 257,000 professionals--about half of those eligible--will have their Medicare payments dinged in 2015 because they didn’t meet MU criteria.  CMS apparently is anticipating that the easy money of MU incentive payments for a year--based on only three months of usage--will draw noncompliant providers back into the fold. And once they start using their EHRs, CMS hopes they will learn to love them. But are those incentive payments enough to make a difference?

We believe they are not enough, because many physicians see the incentive payments as insufficient to cover new EHR or upgrades.  According to one calculation, individual physicians who start MU in 2014 may receive a maximum of $24,000 in cumulative payments through 2016--with $12,000 in 2014, $8,000 in 2015 and $4,000 in 2016. This isn’t enough to cover the acquisition of an EHR, not to mention implementation and training. Such low numbers can be a shock to many physicians, who are disappointed in the small return on what they viewed as semi-heroic efforts to qualify for stage 1. It is such a turnoff that many are concluding that the juice is not worth the squeeze for continued MU participation.

If this paltry carrot isn’t enough to change behavior, neither is the “stick” of payment penalties. CMS estimates that more than half of those facing penalties (142,000 EPs) will see a payment adjustment of between $1 and $1,000. Consider the situation of a three-physician practice with $1.425 million total annual revenue and a 20% Medicare payer mix.  Each physician would earn $95,000 annually for Medicare patients.  A 1% reduction for not meeting MU requirements would translate into a $950 annual penalty per physician, or roughly $4/day.

This isn’t enough of a financial impact to drive a meaningful number of noncompliant docs back to the MU path. Even doubling the financial penalty for noncompliance next year to 2% doesn’t seem like much of a threat in real numbers to many doctors. They are willing to absorb the loss rather than continue in the MU program. Many simply are concluding that the efficiency gained by not focusing on MU-required record-keeping will more than offset the penalties.

Market forces outside of MU also might be impacting attestation numbers. Because many physician practices are being acquired, they are deferring major purchases like EHR upgrades in an effort to keep their balance sheet polished to look good to prospective buyers. 

Finally, the new attestation window may not be long enough for recalcitrant providers to learn to love their EHRs. If doctors need only use their EHRS for three months to qualify for MU attestation, they don’t have sufficient time to be trained and to become proficient enough to integrate new processes into their workflows.

The bottom line.  We applaud CMS for listening to its provider customers and continuing to make improvements to the MU program.  MU’s parameters were set forth in legislation. This didn’t leave CMS much wiggle room on the regulatory side to make implementation improvements. They are playing the hand they’ve been dealt, which, unfortunately, may not be good enough to drive provider behavior toward MU’s requirements.