Tag: EHR Incentives
Fewer American doctors are treating patients enrolled in the Medicare health program for seniors, reflecting frustration with its payment rates and pushback against mounting rules, according to health experts.
The number of doctors who opted out of Medicare last year, while a small proportion of the nation’s health professionals, nearly tripled from three years earlier, according to the Centers for Medicare and Medicaid Services, the government agency that administers the program. Other doctors are limiting the number of Medicare patients they treat even if they don’t formally opt out of the system.
Even fewer physicians say they are accepting new Medicaid patients than new Medicare patients, and the number who don’t participate in private insurance contracts, while smaller, is growing—just as millions of Americans are poised to gain access to such coverage under the new health law next year. All told, health experts say the number of doctors going “off-grid” isn’t enough to undermine the Affordable Care Act, but they say some Americans may have difficulty finding doctors who will take their new benefits or face long waits for appointments with those who do.
CMS said 9,539 physicians who had accepted Medicare opted out of the program in 2012, up from 3,700 in 2009. That compares with 685,000 doctors who were enrolled as participating physicians in Medicare last year, according to CMS, which has never released annual opt-out figures before.
Meanwhile, the proportion of family doctors who accepted new Medicare patients last year, 81%, was down from 83% in 2010, according to a survey by the American Academy of Family Physicians of 800 members. The same study found that 4% of family physicians are now in cash-only or concierge practices, where patients pay a monthly or yearly fee for special access to doctors, up from 3% in 2010.
A study in the journal Health Affairs this month found that 33% of primary-care physicians didn’t accept new Medicaid patients in 2010-2011.
The pullback in Medicare acceptance is being felt in certain quarters. Joe Baker, president of the Medicare Rights Center, said his patient-advocacy group has had an increase in calls from seniors who can’t find doctors willing to treat them—mainly from affluent urban and suburban areas where many patients can pay out of pocket if their doctor doesn’t accept Medicare. “In most places, doctors can’t pick and choose because Medicare is the biggest game in town, or the only game in town,” he said.
Some experts attribute the rise in defections to Medicare payment rates that haven’t kept pace with inflation and the threat of more cuts to come. Under a budgetary formula enacted by Congress in 1997, physicians could see Medicare reimbursements slashed by 25% in 2014 unless Congress intervenes to delay the cuts, which it has done several times.
“Medicare has really been pushing its luck with physicians,” said economist Paul Ginsburg, president of the nonpartisan Center for Studying Health System Change. “By allowing the SGR and its temporary fixes to persist, Medicare is risking a backlash by senior citizens who say, ‘Hey, this program isn’t giving me the access to doctors I need.’ .”
Some doctors say Medicare’s reimbursement rates—as low as $58 for a 15-minute office visit—force them to see 30 or more patients a day to make ends meet. “Family physicians have been fed up for a long time and it’s getting worse,” said Jeffrey Cain, president of the American Academy of Family Physicians. By disengaging with Medicare and other third-party payers, he says doctors can practice based on what patients need, not what insurers will pay.
Other doctors are dropping out of Medicare to avoid deeper government involvement in medicine, much of which is occurring in Medicare. For example, Medicare is now paying incentives to doctors who switch to electronic medical records and who send data on quality measures to the federal government. Doctors who are part of the Medicare program who don’t do so will face penalties starting in 2015.
While the leaders of some large doctor groups have endorsed such initiatives, Dr. Ginsburg says, “there are a lot of physicians, particularly older physicians, who say, ‘I don’t want to do this. Let me run out the rest of my career practicing like I’ve always done.’ ”
Some doctors are particularly concerned about patient privacy. Earlier this year, gynecologist Mary Jane Minkin, a professor at the Yale School of Medicine, opted out of Medicare and the Yale Medical Group when she saw that the electronic records system displayed patients’ gynecological records to other providers they consulted. “There’s no reason the dermatologist has to know about my patients’ libido issues,” Dr. Minkin said.
All but 10 of the 70 Medicare patients in her practice have continued to see her, Dr. Minkin said, even though they must pay out of pocket to do so.
Doctors have three options for dealing with Medicare. Those who participate bill Medicare directly and must agree to accept its reimbursement rates for all covered services. So-called nonparticipating doctors still file Medicare reimbursement claims but can charge as much as 10% over Medicare’s rates for some services, and they must bill patients for the difference. Those who opt out can charge patients whatever they want, but they must forgo filing Medicare claims for two years, and their Medicare-eligible patients must pay out of pocket to see them.
That prospect rankles many elderly people—in part because they must continue paying their Medicare premiums or risk losing their Social Security benefits. Republican-sponsored legislation in the House and Senate would let seniors use their Medicare benefits to pay doctors privately, but opponents believe that would undermine the entire system, and the bills aren’t given much chance of passage.
Doctors who don’t take Medicare say they don’t necessarily raise rates significantly. Some say not having to submit claims and file mandated reports allows them to keep their overhead low. They can also adjust their fees to fit patients’ needs.
“We give discounts to teachers and preachers, and anybody who comes in wearing spurs gets $5 off,” said Juliette Madrigal-Dersch, a pediatrician and internist in Marble Falls, Texas. She says she also treats patients who develop cancer free of charge. “I couldn’t do that if I took Medicare. It’s considered an illegal enticement.” Dr. Madrigal-Dersch is president of the Association of American Physicians and Surgeons, a conservative group that advocates private-pay medicine. “It’s gone from being a fringy, rebellious thing to a business model,” she added.
When the Mayo Clinic’s small family practice office in Glendale, Ariz., stopped taking Medicare in 2009, only about 500 of its 3,500 Medicare patients stayed on. Since then, an additional 250 elderly patients have joined the practice, paying between $200 to $575 a visit. Physicians say dropping out isn’t easy, and some medical specialties are more dependent on Medicare than others.
Smiley Thakur, a kidney specialist in Seattle, stopped taking Medicare, Medicaid and commercial insurance in 2008 and had to resume two years later, mainly because he stopped getting referrals from other doctors. “Patients weren’t interested in how good I was—they only wanted someone who took their insurance,” Dr. Thakur said. “It’s hard to compete with free.”
Aprima Medical Software announced today that over 1,000 former customers of Allscripts MyWay™ have chosen to upgrade to the Aprima PRM, its EHR (electronic health record) and PM (practice management) solution, since last October when Allscripts announced that it would not develop or update the Allscripts MyWay™ product to be in compliance with government incentives and requirements such as Meaningful Use and ICD-10.
Rather than migrate to Allscripts Pro™ – which requires a change in systems, plus a potentially arduous data conversion and retraining period, potentially creating mental, physical and financial disruption to the practice – these providers are taking advantage of the Aprima Rescue Plan™ for customers of Allscripts MyWay™. Since the announcement by Allscripts, Aprima has exceeded the 1,000 provider milestone, with the potential for significantly more providers to choose Aprima by the end of the calendar year.
Customers who have already taken advantage of the Aprima Rescue Plan™ are eager to recommend Aprima to peers who are still on the fence about whether or not to migrate to Allscripts Pro™ or another EHR vastly different from Allscripts MyWay™.
Some of our new customers have told us they were concerned that they would lose their financial data if they converted to Allscripts Pro™. For customers of Allscripts MyWay™ who have upgraded to Aprima, this has consistently proven to be a non-issue.
For Dr. Lauranne Harris, the financial benefits were almost instantly apparent. For months before upgrading to Aprima, her practice had struggled with the Allscripts MyWay™ billing module. The situation was immediately resolved after upgrading to Aprima. “The day after the practice went live a professional trainer arrived to train us on Aprima. We got $100K in billing out the door that day and within a week, we had received $25,000 in payments,” Dr. Harris recalled.
J. Woodson Dermatology & Associates reaped benefits that were nothing less than the driving reason to go paperless. Thanks to Aprima EHR’s “one click” insurance eligibility checking, the practice no longer has to assign a full-time employee to this previously tedious task. “In my opinion, there was nothing comparable to that in Allscripts MyWay™,” practice administrator Lori Haynie said. J. Woodson Dermatology & Associates is currently scanning all of its images and charts within the Aprima EHR, another functionality that, according to Haynie, Allscripts neglected to train the practice how to use.
“Aprima is very pleased to recognize this important milestone of upgrading 1,000 former customers of Allscripts MyWay™, with many, many more expected in the weeks and months ahead,” stated Michael Nissenbaum, president of Aprima. “I am looking forward to meeting many of them at the upcoming Aprima User Conference on August 2-4 in Dallas.”
The Aprima Rescue Plan™ circumvents the need to switch to another Allscripts EMR product and offers customers the following advantages:
- Free Aprima licenses for each Allscripts MyWay™ license – no need to repurchase software; up to an $8,500 savings per provider
- Similar look and feel; Aprima has made nearly 1,000 enhancements since it licensed the original source code to Allscripts in 2008, including hundreds of substantive improvements to the PM system
- Minimal learning curve, since it is only needed for the new features
- Minimal downtime compared to what is typical when changing systems and having to re-learn many new workflows
- Existing data remains intact; this is a proven product upgrade, not a conversion
- U.S.-based support
For information on the Aprima Rescue Plan™ for customers of Allscripts MyWay™, call 813-774-9800, option 2 or contact us here.
About Aprima Medical Software, Inc.
The Aprima EHR/PM is an integrated system built on a single database. Aprima uses a fast, flexible design that adapts automatically to a physician’s workflow and sets the benchmark for ease-of-use, speed and flexibility. Aprima is one of the few companies with a 15-year track record of success, including CCHIT Certification consistently every year as well as ONC Certification for 2011/2012. Thousands of Aprima users are benefiting from improved quality of care, improved patient satisfaction, improved quality of life and an improved bottom line.
Aprima is a registered trademark of Aprima Medical Software. All other trademarks are the property of their respective owners. Allscripts MyWay™ is a product of Allscripts HealthCare Solutions, LLC. Aprima is not affiliated with Allscripts HealthCare Solutions, LLC.
Click here to learn more about making the switch today!
Doctors Administrative Solutions (DAS) CEO, David Schlaifer and Director of Government Affairs, Mallory Tai Taylor made their second visit to the White House on Monday, June 24, 2013 as champions for independent physicians.
Schlaifer and Taylor participated in The Obama Administration’s Roundtable on Health IT and Exports, which focused on promoting the sale of Health IT internationally while also heeding the need to develop sound regulations and practice protocols necessary to successfully integrate electronic health care management systems across the global marketplace.
“It’s an honor to collaborate with some of the most respected and influential thought leaders in the Health IT industry, while also a significant responsibility to the health care providers we serve,” explained Schlaifer. “The constantly changing marketplace means our clients, some of the nation’s more than 289,000 independent physicians, need a strong voice at the table to ensure their unique business challenges and concerns are not only heard but also addressed.”
Roundtable participants reviewed the current progress of integrating health IT systems in the domestic marketplace. A critical evaluation of successful case studies and setbacks were used to establish key benchmarks for best practices in the global marketplace.
Included in the discussions co-hosted by Business Forward were Francisco Sanchez, Under Secretary of Commerce for International Trade; David Muntz, Principle Deputy National Coordinator, Office of National Coordinator, U.S. Department of Health and Human Services; Claudia Williams, Health IT Liaison, White House Office of Science and Technology Policy; among other notable business leaders representing such organizations as Oracle and Intel.
“We’re pleased by how the effort to expand our nation’s burgeoning health care IT infrastructure into the global marketplace is being so thoughtfully planned and considered by top White House officials,” explained Schlaifer. “As the dividing line between the domestic and international marketplace becomes increasingly blurred, having collaborative IT systems in place will be an essential component to providing quality health care.”
About Doctors Administrative Solutions (DAS)
Now entering its second decade, DAS has emerged as a top market leader providing electronic health record (EHR),practice management (PM) and revenue cycle management (RCM) solutions to health care providers that want to prioritize patient care over paperwork. Headquartered in Tampa and with its newest office located in the New York metropolitan area, prioritizing customer service has made DAS an EHR provider with a 100 percent meaningful use attestation success rate among its rapidly growing network of 3,000 system users.
About Business Forward
Business Forward is an organization that helps ensure business has a voice at the policy table -specifically, one that helps build stronger support for policies that promote America’s economic competitiveness.
A major Electronic Prescribing (eRx) Incentive Program deadline is approaching for both individual eligible professionals (EPs) and group practices participating in the Group Practice Reporting Option (GPRO). If you are an EP or an eRx GPRO participant, you must successfully report as an electronic prescriber before June 30, 2013 or you will experience a payment adjustment in 2014 for professional services covered under Medicare Part B’s Physician Fee Schedule (PFS.) The 2013 eRx Incentive Program 6-month reporting period (January 1, 2013 to June 30, 2013) is the final reporting period available to you if you wish to avoid the 2014 eRx payment adjustment. If you do not successfully report, a payment adjustment of 2.0% will be applied, and you will receive only 98.0% of your Medicare Part B PFS amount for covered professional services in 2014. This deadline does not apply to you if the eligible professional achieves Meaningful Use under the Medicare or Medicaid EHR Incentive Program during the 12-month eRx reporting period (1/1/12-12/31/12) or the 6-month eRx reporting period (1/1/13-6/30/13) and attests during the 6-month reporting period (1/1/13-6/30/13). See other exceptions below: Avoiding the 2014 eRx Payment Adjustment Individual EPs and eRx GPRO participants who were not successful electronic prescribers in 2012 can avoid 2014 eRx payment adjustment by meeting specified reporting requirements between January 1, 2013 and June 30, 2013. Below are the 6-month reporting requirements:
- Individual EPs – 10 eRx events via claims
- eRx GPRO of 2-24 EPs – 75 eRx events via claims
- eRx GPRO of 25-99 EPs – 625 eRx events via claims
- eRx GPRO of 100+ EPs – 2,500 eRx events via claims
Exclusions and Hardships Exemptions Exclusions from the 2014 eRx payment adjustment only apply to certain individual EPs and group practices, and CMS will automatically exclude those individual EPs and group practices who meet the criteria. CMS may exempt individual eligible professionals and group practices participating in eRx GPRO from the 2014 eRx payment adjustment if it is determined that compliance with the requirements for becoming a successful electronic prescriber would result in a significant hardship. Requests for hardship exemptions must be submitted through the Communication Support Page by 11:59pm ET on June 30, 2013. More information on exclusion criteria and hardship exemption categories can be found on the Electronic Prescribing (eRx) Incentive Program: 2014 Payment Adjustment Fact Sheet. Questions about eRx? If you have questions regarding the eRx Incentive Program, eRx payment adjustments, or need assistance submitting a hardship exemption request, please contact the QualityNet Help Desk at 866-288-8912 (TTY 1-877-715-6222) or via firstname.lastname@example.org. The Help Desk is available Monday through Friday from 7am-7pm CT.
Florida health care providers have received $977 million in incentive payments for electronic health records meaningful use, the third highest amount paid to any state.
Data from the Centers for Medicare & Medicaid Services shows that since the health records incentive program started in 2011, a total of $14.4 billion has been paid to about 350,000 eligible hospitals and other providers.
In the first three months of this year, $290 million was paid out in the incentive program.
So far, California has received the most – $1.2 billion since the program’s inception.
At $1.1 billion, Texas ranked second among the states in incentive payments.
We hold our doctors’ hands when it comes to attesting for meaningful use. Learn how you can become one of them today. Contact us!
More than half of U.S. doctors have switched to electronic health records and are using them to manage patients’ basic medical information and prescriptions, according to federal data set to be released Wednesday.
The Department of Health and Human Services says it has reached a tipping point as it seeks to steer medical providers away from paper records. Advocates for electronic health records say they have the potential to make medical care safer and more efficient. In 2015, the federal government will start penalizing providers that haven’t begun using electronic health records in reimbursements they get for treating patients.
But some doctors have been cautious about changing long-standing practice, saying that typing into a computer while talking with patients requires more attention than taking notes by hand. Others are concerned that electronic systems don’t allow for enough family history or fail to highlight the important parts of a patient’s medical record. Some critics also cite privacy concerns.
Overall, some 291,325 doctors and other providers—or around 55% of the office-based providers eligible for federal incentives in exchange for adopting electronic records and using them at a set level—have received payments, the department said. Some 3,880 hospitals have also made the change. Doctors have been paid about $5.9 billion to date for participating in an incentive program established under the 2009 economic-stimulus law. An additional $8.7 billion has gone to hospitals, according to HHS data.
To get the funds, providers must have set up electronic systems that contain patients’ records, with details such as blood pressure, weight, height and medications. They also must write prescriptions electronically. The new systems are also designed to make some recommendations to providers when they enter orders into them, such as the potential for an allergic reaction to a drug.
Even medical practices that qualify for the federal payments may still use paper for some tasks, such as taking information from patients when they come for appointments. Some doctors have complained that their system gives them unnecessary warning alerts.
“Please, be patient with your physician as they transition to this,” said Farzad Mostashari, national coordinator for health information technology at HHS. “The ‘under construction, pardon our appearance’ sign—that’s the phase we’re in.”
Hospitals and doctors that have hit the current standard for using electronic records are being encouraged to move to a higher stage at which they can share information with other doctors and send patients electronic reminders or summaries of their visits.
David Blumenthal, who preceded Dr. Mostashari as national coordinator at HHS, said the agency had made a conscious decision not to push providers too far too quickly.
“It’s a matter of getting people on the escalator and moving them steadily up to higher and more demanding uses. You can’t get from the bottom of the escalator to the top in one step; you have to take them along for the ride,” he said. Dr. Blumenthal said he expected most of the remaining providers to come on board within five years.