EHR Incentive Programs: Improving Access to Care

The 2014 Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs were developed to provide financial incentives to eligible professionals, eligible hospitals, and Critical Access Hospitals (CAHs) to achieve meaningful use of certified EHR technology with the goal of improving patient care.  The programs worked to prompt healthcare providers to adopt, implement, upgrade, or demonstrate meaningful use of certified EHR technology.  In her May 18, 2015, article in RevCycleIntelligence, Jacqueline DiChiara reported by the end of 2014, EHR incentive payments reached over $28 billion with eligible hospitals receiving more than $17 billion, Medicare and Medicaid-eligible professionals collectively receiving nearly $10 billion.  However, there are some changes with the EHR Technology Incentive Program that may affect your revenue—and not in a good way.

In the amended American Recovery and Reinvestment Act of 2009 (ARRA), Congress included provisions in the Medicare and Medicaid EHR Technology Incentive Program for CAHs, as well as eligible professionals and hospitals, who did not successfully demonstrate meaningful use of Certified EHR Technology to experience a negative payment adjustment to their reimbursement.  Effective January 1, 2016, payment adjustments will be applied for those Medicare-eligible professionals not meeting the criteria for meaningful use in the Medicare EHR Incentive Program.  For eligible hospitals, payment adjustments were applied as of October 1, 2014.  Interestingly, DiChiara notes over 28,000 eligible professionals reported a 2% decrease in their 2015 Medicare payments for not meeting the standards related to Electronic Prescribing (eRx) and the Medicare EHR Incentive Program.  CAHs unable to demonstrate meaningful use for the applicable reporting period of fiscal year (FY) 2015 will have a decrease in their reimbursement, from 101% of its reasonable costs to 100.66%, according to CMS.gov.  For 2016, the percent of reasonable costs reimbursement decreases to 100.33% and then down again to 100% for 2017 and for each year thereafter, well into years 2020 and beyond.

CAHs were created to preserve access to primary and emergency care services in isolated rural areas by improving the financial conditions of CAHs and, subsequently, preventing some closures.  Choices Magazine article, “Performance of the Critical Access Hospital Program: Lessons Learned for Future Rural Hospital Effectiveness in a Changing Health Policy Landscape,” highlighted the CAH program grew rapidly from 41 hospitals in 1999 to 1,055 hospitals in 2005 and to 1,327 CAHs in 2011 because of the 1983 Medicare switch from cost-based reimbursement to the Prospective Payment System (PPS).  CAHs now face possible Medicare cuts.  Hopefully, the following information from CMS.gov can help CAHs effectively avoid EHR Incentive Program payment adjustments and ensure their financial longevity as Medicare and Medicaid providers.

• Hardship:  A CAH may, on a case-by-case basis, be exempted from this adjustment if the CAH can demonstrate, on an annual basis, becoming a meaningful user of EHR technology would result in a significant hardship. However, in no case will a CAH be granted an exemption for more than five years.
  • July 1, 2015: 2016 Eligible Professional (EP) Medicare EHR Incentive Program Hardship Exception Application Deadline
  • CAHs can apply for hardship exceptions in the following categories:
    • Infrastructure — CAHs must demonstrate they are in an area without sufficient internet access or face insurmountable barriers to obtaining infrastructure (e.g., lack of broadband).
    • New CAHs — CAHs with new Centers for Medicare & Medicaid Services (CMS) Certification Numbers (CCNs) not having had time to become meaningful users can apply for a limited exception to payment adjustments. The hardship exception is limited to one full year after the CAH accepts its first patient.
    • Unforeseen Circumstances — Examples may include a natural disaster or other unforeseeable barrier.

• Meaningful Use:  In order to avoid the payment adjustments, CAHs must demonstrate meaningful use within the full federal fiscal year that is the same as the payment adjustment year. The adjustment would then apply based upon the cost reporting period beginning in the payment adjustment year (that is, FY 2015 and thereafter). Thus, if a CAH is not a meaningful user for FY 2015 and thereafter, the adjustment would then be applied to the CAH’s reasonable costs incurred in a cost reporting period beginning in that affected fiscal year.
  • An eligible hospital or CAH demonstrates meaningful use by successfully attesting through either the CMS Medicare EHR Incentive Programs Attestation System (https://ehrincentives.cms.gov/) or through its state’s attestation system.
  • CAHs are required to submit their attestations for meaningful use by November 30th of the following fiscal year. For example, if a CAH is attesting it was a meaningful EHR user for FY 2015, the attestation must be submitted no later than November 30, 2015, in order to avoid payment adjustments.
  • Eligible hospitals and CAHs participating in meaningful use for the first time this year may attest to a 90-day reporting period for FY 2015. CMS is allowing eligible hospitals and CAHs participating in meaningful use for the first time the ability to attest. The hospitals must first register in the CMS Registration and Attestation System at: https://ehrincentives.cms.gov/hitech/login.action. Once the registration is active, the hospital should contact Elizabeth Holland at elizabeth.holland@cms.hhs.gov and provide the hospital name, CCN, and contact person information.

• Call CMS Information Center:  Ask questions, get more information.  Dial 888-734-6433 then dial 1 for the EHR Information Center.