Will Chiropractors Incur Penalties for No Meaningful Use?

A lot has been spoken about Medicare incentives in connection with demonstrating meaningful use via your EMR program.  Understandably, many chiropractors are growing tired of the nearly endless assault of stimulus ads by software companies touting how much money you can potentially earn back by using their certified program.

This is not to say these ads are untrue.  Meaningful use incentives are the real deal.  In fact, real “live” chiropractors have obtained them and will continue to do so.But today, I’d like to focus your attention on the other side of the issue. 

Obviously, if the stimulus is the carrot designed to entice us towards meaningful use…then bringing up the rear is the stick aimed at our backsides in an attempt to force compliance.  Today, er…we will focus on the backside. (Awkward? Yes.  Necessary. Oui.)

Carrots Getting Smaller, Sticks Rapidly Approaching

While incentive payments are getting smaller with each subsequent year (until they phase out completely), Medicare has clearly stated that there will be penalties applied to eligible professionals who do not adopt or successfully demonstrate meaningful use of certified electronic health record technology by 2015.

Specifically, the eligible professional’s fee schedule will be reduced by 1% each year as follows:

  • 2015 – 99% of Medicare physician fee schedule covered amount
  • 2016 – 98% of Medicare physician fee schedule covered amount
  • 2017 and each subsequent year – 97% of Medicare physician fee schedule covered amount

And here’s the big stick…

  • If < 75% of all EP’s have become meaningful users by 2018, then the adjustments continue to reduce by 1% each year until a maximum of 5% penalty is waged (so that = 95% of Medicare allowable)

The Meaningful Use Deadline is Closer Than You Think

Procrastinators beware! On the surface, it appears that you have until 2015 to get your act together.  However, penalties are based on activities of the two years prior!

In other words, you have until the end of 2013 to demonstrate meaningful use in order to avoid penalties in 2015.

Before You Panic, Do the Math

Lest I begin to sound like some EMR salesman or (worse) like Big Brother trying to scare you into compliance, I am going to give you one of my favorite “take this all with a grain of salt” reminders: do the math before you panic.

For some of you that have a miniscule Medicare practice, even a 5% reduction is not enough to frighten you or even prod you towards the trouble of demonstrating meaningful use.

For example:

  • Let’s say you received only $5000 in reimbursements from Medicare for a calendar year (or, if you are Non-Par, your patients did).
  • Let’s also assume that your covered amounts equaled $25 per visit (unfortunately, not far off the Medicare rates in most parts of the country).
  • That math equates to 200 visits @ $25 per visit = $5000.
  • A 5% reduction means that you will be paid $23.75 instead of $25 per visit
  • Your total penalty for the year would be $250 and on a visit basis, you would get paid $1.25 less (or your patient would be forced to pay $1.25 more if you are Non-Par)
  • Quite frankly, for some folks the $250 per year loss ain’t worth the trouble – sleep easy.
  • On the other hand, if you are a bigger Medicare player and are attempting to capture meaningful use incentives doing the math NOW may help you avoid disappointment later.

Exceptions? (AKA “But what about my office?”)

In order to avoid the onslaught of emails exclaiming, but…but…but – here are a few words about exceptions.

Medicare does have a process outlined for hardship exceptions for physicians whose circumstances “pose a significant barrier to achieving meaningful use.”

Exceptions may be granted for the following circumstances (but are not guaranteed):

  • You practice in a Quonset hut with no internet (or any significantly remote place with no broadband internet capability)
  • Your office is hit by a barrage of boll weevils and needs to shut down temporarily (or other unforeseen circumstances)
  • Your cable company runs a month-long 24/7 series of Matlock re-runs and mysteriously, all your seniors fail to show for their appointments (or other barriers to patient follow-up)
  • You’ve been in practice less than 2 years (and are now wondering what you got yourself into) – you may be given a delayed requirement.

Interestingly enough, the Medicare link for info on how to apply for hardship exceptions was broken at the time of this writing.  Stay tuned for details (maybe).

What to Do Next…

My first suggestion (again) is to do the math. Be informed and make your decision either way, but do the math and don’t listen to the hype or panic.

Then, if you choose to act, do so quickly!

Finally, if keeping up with all of these compliance regulations seems to be getting you down, you might want to consider our Chiropractic Audit Armor program – an interactive compliance training that teaches you and your staff how to maintain compliance with HIPAA privacy & security rules, Medicare, fee schedules and more (as well as sends reminders about upcoming deadlines).  And it is combined with a “mystery caller” service to ensure that your staff are properly communicating to your patients on the phone in the areas of compliance and new patient generation.  See our Chiropractic Audit Armor page for more info.



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