According to CMS, more than 460,000 of the 1.25 million eligible Medicare providers did not meet deadlines to submit data for the Physician Quality Reporting System in 2013. The agency noted that about 70% of those who did not meet the deadlines see fewer than 100 Medicare patients annually. Nearly 40 percent of healthcare providers treating Medicare patients will have their payments docked 1.5% this year because they did not submit data on patients’ health to the government. However, nearly 642,000 providers did comply in 2013 and will earn a 0.5% boost in payments this year. For many small practices, the administrative burden was predicted to be significant, with analysts believing some groups will find incurring a penalty worth more than complying with government data requests.
All of this is especially important given the new MACRA legislation which puts forth a new formula for calculating payments to providers who treat Medicare patients. With the regulations and proposals from HHS forthcoming in the next year or two, there will be a window of time for physicians to help design the new programs.
However, this also illustrates the many regulatory and legislative challenges facing physician practices today. Electronic health records are one example, as a recent widely circulated editorial by Charles Krauthammer argued that new regulations have demoralized doctors and degraded care by pushing providers to quickly adopt electronic health records. This is especially relevant as we await the publication of an upcoming final rule related to electronic health record adoption in the United States.
Krauthammer cites one physician’s concern of “a never-ending attack on the profession from government, insurance companies, and lawyers … progressively intrusive and usually unproductive rules and regulations,” topped by an electronic health records (EHR) mandate that produces nothing more than “billing and legal documents” — and degraded medicine.
It is not surprising, then, that groups like the American Medical Association have repeatedly called upon the government to modify its Meaningful Use program associated with EHRs. AMA argues it requires electronic records to serve too many functions and forcing the fledgling EHR industry to develop too quickly to respond to users’ concerns. The numbers of those who have satisfactorily met Meaningful Use requirements continues to be lower than the government’s expectations. And years after the program’s beginning, AMA saw only about 10% of eligible providers as qualified for the next rounds of Meaningful Use. Soon, physicians and hospitals that have not adopted EHR systems will face cuts in Medicare reimbursement.
Outside of health records, providers also want CMS to reverse its decision on other quality issues, specifically its quality-measure reporting requirements as described in a proposed 2016 prospective payment rule for acute and long-term-care hospitals. CMS plans to require inpatient hospitals to submit details on meeting several new quality metrics by Oct. 1, 2017.
Providers are concerned because the suggested quality measures lack endorsement by the National Quality Forum, which is viewed by industry and regulators as having the top standard for endorsing best practices that ensure the health of patients. According to Modern Healthcare, the lack of endorsement gives the field “limited insight on whether the measures are reliable, accurate and feasible enough for public reporting programs,” the American Hospital Association said in a comment letter. “The measures also do not seem to be focused on any concrete national priority area or goal for improving care … CMS provides little explanation for why the conditions covered by its Medicare spending measures are more important to address with measures in the IQR program than other conditions”.
Under the branding of “quality” improvements, government regulations of the healthcare industry have steadily created a nightmare of administrative burdens, confusing requirements, and in general a demoralized healthcare workforce.
Ultimately, all of these new laws and regulations are especially difficult on smaller practice groups. And if they do not perform according to the new government-created standards, they will be squeezed harder than ever. According to one consultant: “It used to be that physicians made enough money that they could let a lot of things slide. The margin is so much thinner now. You do have to micromanage the money. No one taught us to do that.”