12 Changes That Will Affect Doctors' Income in 2015

Leigh Page

Disclosures

November 25, 2014

In This Article

8. Meaningful Use Moves From Carrot to Stick

In 2015, Medicare's meaningful use (MU) program for electronic health records (EHRs) moves from the carrot to the stick. Starting next year, physicians can no longer begin applying for MU bonuses, and the bonuses end in 2016. Meanwhile, penalties for not entering the MU program begin next year, starting at 1% of Medicare payments and moving to 3% by 2017.

But even as the fines kick in, some physicians are defiantly refusing to join, and even dropping out. "The MU program is interfering with the practice of medicine," said Hayward K. Zwerling, MD, a Massachusetts endocrinologist who dropped out recently. He said he would rather pay the penalties than see his practice diverted by what he sees as a very demanding program that does little to improve patient care.

Dr Zwerling has an unusual perspective because he developed and marketed his own EHR system, called ComChart. It won a KLAS award and was certified for stage 1 MU, but he decided not to offer it for stage 2 certification. "I decided I did not want to go any further," he said. Although he agrees that EHR can make a practice more efficient, he said studies don't show that it reduces the overall costs of healthcare or improve quality.

To some extent, Dr Zwerling is swimming against the tide. According to a Medscape survey[11] in July 2014, more than three quarters of doctors who have an EHR are now attesting to MU, up from less than one half in 2012. However, this year's survey also found that 16% of physicians say they will not attest to MU, up from 14% in 2012. And an additional 6%, like Dr Zwerling, said they were abandoning MU after meeting requirements in previous years.

Even though doctors are going along with MU, the Medscape survey showed substantial discontent. It found that 70% of respondents said EHR decreases their face-to-face time with patients, and 57% said it detracts from their ability to see patients. EHR demands are significant. In another recent survey,[12] internists reported that they spent 48 minutes a day on average dealing with EHRs. "The health IT community says that more IT is better," Dr Zwerling said. "My response is, 'Prove it!'"

9. Penalties Start Under PQRS, and the Value-Based Modifier

Just like the MU program, Medicare's quality reporting system is moving to penalties in 2015. Through 2014, the Physician Quality Reporting System (PQRS) was a voluntary program in which physicians provided data on meeting selected quality measures. There hasn't been any incentive payment for reporting PQRS data, but physicians who participated in the maintenance of certification (MOC) program with their specialty board received a 0.5% increase in Medicare reimbursements. But the MOC payments end this year, and a penalty for not reporting PQRS data starts at 1.5% next year, based on 2013 reporting, and rises to 2% in 2016, based on 2014 reporting.

Meanwhile, CMS has begun to analyze the data that has been reported and is beginning to reward and penalize practices based on meeting benchmarks through a process called "quality tiering." The process involves applying a value-based modifier (VBM) to their Medicare payments; it begins in 2015 with penalties and bonuses for large physicians groups of 100 or more "eligible professionals," and will widen out to smaller groups in succeeding years. CMS said only a minority of practices would receive either bonuses or penalties in the VBM process. In a CMS analysis[13] of 2012 physician data, just over 8% of practices would have earned a bonus and 11% would have been penalized.

"This is part of CMS' plan to move from 'more' to 'better,' " said Michael La Penna, a healthcare consultant in Grand Rapids, Michigan, referring to the ongoing movement away from fee for service reimbursements that reward volume to value-based reimbursements that reward outcomes. But he doubts that the VBM program will inspire physicians to make the move.

"Doctors don't get excited about getting checks from programs they don't understand," he said. He recalled that back in the 1990s, when doctors were involved in risk pools for capitated payments, "I would hand the doctor a check for $11,000 for the risk pools. They'd take it, but they didn't ask, 'How do I get that?'" he said. "They were more interested in doing their work each day."

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