Recent CMS reports highlight the fact that many physicians’ response to supposed care improvement initiatives for Medicare is to just ignore them and forego the incentive payments they might get or eat the penalties they incur. (CMS Fact Sheet) (CMS EHR Report) Some of the major programs that doctors have to respond to include the Value-based Payment Modifier, the Physician Quality Reporting System (to ultimately be subsumed in the value-based purchasing program), the Meaningful Use (has there ever been a worse euphemism applied to a government program) electronic medical record program, originally giving incentives, now levying penalties for non-use, and the e-prescribing initiative. According to CMS, participation is continuing to rise, with 51% of the 1.25 million professionals eligible for the quality reporting program filing data in 2013. As you can see, that means almost half didn’t participate. Those who do participate get a one-half percent payment increase. 470,000 professionals were subjected to a negative payment adjustment in 2015, generally of 1.5%. Out of these, 98% were penalized because they didn’t try to participate. For 2013, the last year of the e-prescribing incentive, around 47% of eligible doctors participated. The EHR program is whacking 257,000 doctors with penalties this year, usually a 1% payment reduction. The penalties go up the next two years and eventually the physicians could lose 9% of payments.
In fairness to CMS (although not sure why we should be worried about fairness to an agency that spends billions of taxpayer dollars doing marketing and PR on its work), many physicians have very small Medicare patient loads, so for them the effort definitely doesn’t pay off and the penalties are insignificant. 43% of those not participating in the quality reporting program treat less than 25 Medicare beneficiaries a year. But doctors broadly feel the programs don’t contribute to better care and take up immense administrative time and are often duplicative. The value-purchasing program is the mother of all quality programs and has a horrible mishmash of hundreds of measures. CMS claims it is working to rationalize all the programs and reduce the burden of compliance, but don’t hold your breath on that. You can see that what this really is is an opportunity for CMS to reduce spending by impossible to avoid penalties.