POCP Blog

By Michael Burger, Senior Consultant

Another Meaningful Use (MU) attestation deadline is here. If the past is prologue, physician attestation rates will continue to be much lower than expected. This has policymakers scratching their heads as to what’s going on, and questioning the return on their meaningful use investment. In a story reported by website Politico, Rep. Michael Burgess (R-Texas), a former obstetrician/gynecologist, was quoted last month saying. “As we get to the end of those dollars and they’ve been expended, have we gotten what we’ve asked for?” “Probably not exactly, and some of that responsibility lies in the United States Congress for sure.”

Like many things in life, it’s all about the money. Or is it?

As we’ve been saying for a while, there’s a small but growing cohort of physicians who are willing to withstand the MU penalties rather than move their practices into stage 2. Why? Because the MU penalty phase isn’t enough of a financial hit to negatively affect the bottom line. The result: signing up for–or continuing on with–MU isn’t really worth it.

This is very counterintuitive to the “carrot and stick” design of the program. MU was created by policymakers on the premise that incentive payments would get physicians on board by eliminating a primary objection – cost.  And if the incentives weren’t enough, the dings to their Medicare reimbursements would pull them into the MU fold.

However, given the drops in attestation rates, something else appears to be going on. A little back-of-the-envelope math provides some insights.

In an interview in  Modern Healthcare, Jason W. Mitchell, MD, former Director of the Center for Health Technology at the American Academy of Family Physicians (AAFP), explained why medical practices may decide to take the penalties in lieu of participating.

He pointed to a scenario of the average family doctor, who receives about $100,000 annually in Medicare reimbursements. If there’s a 1% penalty for failing to achieve Meaningful Use Stage 2 in 2014, this will cost about $1,000 in 2015. These penalties escalate to 2% in 2016 and 3% in 2017—a combined three-year total of just $6,000, he explained.  “Add that $6,000 in Medicare penalties to additional incentive payments they won’t receive by failing to achieve Stage 2, and it doesn’t represent a catastrophic loss of income.”

While this is an interesting observation, digging down another layer offers more possible reasons why physicians may be bailing on MU stage 2. A hit of $6,000 in gross income for the MU penalty phases amounts to the typical physician seeing an additional 40 patient visits per year (@ $150/visit). That’s less than one patient visit a week.

Moreover, if physicians are concerned that using an electronic health record (EHR) slows them down, NOT using an EHR (or not using the EHR to track the MU measures, which many feel are irrelevant anyway) easily enables the doctor to add 40 more visits annually.   Even if they only see two additional patients a week, they’ll more than overcome the penalties.

While some may consider this to be a contrarian view of MU, we suggest that this is one way some physician practices are viewing MU stage 2 and why they are taking the penalties in lieu of participation. It’s all about the money. Or is it?

• Post Categories
• Meaningful Use