Payment Plans
IN AN ATTEMPT to encourage eligible professionals to join the Medicare program quickly, CMS and ONC established a payment schedule that offered the highest dollars to the earliest participants. Those who qualify for a first payment in 2011 and
2012 are eligible to receive the full $44,000; the total diminishes in the following years. The incentives stop and the penalties
start in 2015.
PAYMENT AMOUNT BY YEAR
2011
2012
2013
2014
2015
2016
TOTAL PAYMENT
QUALIFIES TO RECEIVE FIRST MEDICARE INCENTIVE PAYMENT IN…
2015
-
-
-
-
-
-
-
The Medicaid program differs significantly. Eligible professionals receive the same payments over a six-year period, regardless
of when they start: $21,250 in the first year and $8,500 in each of five subsequent years. They must qualify for their first payment
no later than 2016. There are no penalties under the Medicaid program.
Hospitals in the Medicare program can begin receiving EHR incentive payments in any year from FY 2011 to FY 2015, but
payments will decrease for those that start receiving payments in 2014 and later. Hospitals that do not successfully demonstrate meaningful use by FY 2015 will be subject to payment adjustments.
Eligible hospitals that qualify for Medicaid incentive payments may begin receiving payments in any fiscal year from 2011 to
2016. While the law defines a payment year in terms of a federal fiscal year (FY) beginning with FY 2011, a hospital does not
have to begin receiving incentive payments in FY 2011.
All of the hospitals and all but 137 of the physicians attested
successfully, said Robert Tagalicod, director of the Office of e-Health Standards and Services at CMS. In total, nearly $400 million in payments had been issued through both programs during the period.
The number of participants may seem low, but it does not indicate a lack of interest in the program. Approximately 77,000
providers have registered for the programs, and attestation is
growing each month. The number of physicians who successfully attested to stage 1 jumped 147 percent from June to July,
rising to 566.
“The numbers are appearing to be increasing, and so we’re
hopeful that that will be a continuing trend,” Elizabeth Holland,
CMS’s director of health IT initiatives group, told the Health IT
Policy Committee.
CMS respresentatives estimate there are “hundreds of thousands” of eligible professionals and hospitals, according to a
discussion with the policy committee.
On the Medicaid side, where 21 states were open for registration as of August, incentives have been paid to 3,500 physicians
and hospitals. Under the Medicaid version of the program, providers can receive payments in the first year for the adoption,
implementation, and upgrade of certified EHR technology.
They do not need to demonstrate meaningful use.
On average Medicare’s early attesters who successfully met
the measures did not just squeeze by. Instead they “greatly exceeded” the required measurement, Tagalicod told the policy
committee. For example, providers on average used computerized physician order entry for 87 percent of medication orders
for unique patients during the attestation period, far beyond the
designated threshold of 30 percent.
However, CMS warns against reading too much into the early
results. In the case of CPOE, for example, the percentage may
fall in time because it is assumed that many of the early attesters have mature systems in place and their use is consequently
higher than that of new users. Rates may decrease as new adopters begin to attest.
Smoother Sailing for Experienced Crews
The biggest achievement of stage 1 to date has been just getting
people onboard a program that will equip a nation of providers
to better treat their patients, says Sanin Rahman, senior consultant at consulting firm Arcadia Solutions.
“One of the biggest successes is the fact that the industry took
to meaningful use as much as it did, and the fact that it is driving
more and more providers at a scale—that is honestly unprecedented—towards EHRs,” Rahman says.
CMS intended stage 1 primarily to motivate providers to implement EHRs, more so than driving improvements in healthcare quality. That comes later, says Rahman, who is currently
