Half of Physicians Face Payment Penalties from Medicare

CMSMore than 257,000 U.S. doctors will see their Medicare payments cut by 1% next year because they didn’t meet federal goals for using electronic medical records, according to the Centers for Medicare and Medicaid Services.

"Eligible professionals needed to have successfully demonstrated meaningful use for an EHR reporting period in 2013 or qualified for a significant hardship exemption from CMS to prevent a negative one percent (-1%) reduction in their Medicare Physician Fee Schedule payments for covered professional services furnished Jan. 1, 2015 through Dec. 31, 2015," according to the statement from CMS.

Some 28,000 providers will be docked another 1% of Medicare pay for not prescribing medications electronically. About 200 hospitals were informed in October that they also will lose 1% of their Medicare payments in 2015 for missing a deadline for EMR use.

The cuts will be levied on every Medicare bill during the year, even if the doctors and hospitals have since complied. A CMS spokeswoman said the affected doctors are being informed of the fee cuts by mail.

Beginning next year, providers face additional cuts in their Medicare payments under other federal laws. Under the Physician Quality Reporting System, part of a 2008 law, doctors treating Medicare patients must submit data to the federal government on such measures as blood pressure, weight and antibiotic use, or face fines of 1.5% in 2015, rising to 2% a year through 2019. The Value-based Modifier program, part of the Affordable Care Act, requires doctors to report additional cost and quality data on Medicare patients—and will reward or penalize some providers based on a patient’s total bills.
And under yet another program established by the health law, CMS announced that 724 hospitals will have their Medicare payments cut 1% for all patients in 2015 for lackluster performance in reducing adverse events such as bed sores and pulmonary embolisms during hospital stays.

In addition to these multiple fines, Medicare payments to physicians also are set to decline by 2% across the board every year under the deficit-reduction rules.

According to the AMA, these cuts and fees when combined, could cost a doctor a total of 11% of their Medicare billings by 2017.

Seems that the government's effort to encourage reform could use some coordination and rationalization. Most doctors are so confused by the muddled regulations, changing requirements and confusion that the only thing they can feel certain of is that their reimbursement from Medicare is going to take hit.

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