Coordinator for HIT, is led by major collaborative efforts at The University of Texas at Houston (UT-Houston) and other institutions. UT-Houston is lead- ing innovative cognitive research to har- ness the power of health IT to integrate and support physician reasoning and decisionmaking in the care of patients.
Physician incentives: who and how much Medicare and Medicaid each have an incentive program, as explained below. Physicians are eligible for both pro- grams; however, they must choose only one. The eligibility for ancillary provid- ers varies by program. For the Medicare program, physicians, dentists, podiatrists, optometrists, and chiropractors are eligible. Under Med- icaid, eligibility applies to physicians, dentists, nurse practitioners, and certi- fied nurse midwives, and to physician assistants who lead a rural health clinic (RHC) or federally qualified health cen- ter (FQHC).
Ineligible for incentives under either
program are long-term care facilities such as nursing homes as well as physi- cians who perform more than 90 percent of their services in a hospital setting (based on claims reporting and place of service codes 21 and 23). Because hos- pitals receive incentives, physicians who
practice in a hospital setting most likely benefit from them.
Medicare incentives. Table 1, below, shows the incentives physicians may earn through the Medicare EHR incen- tive program. 2014 is the last year phy- sicians can begin the program and still receive the incentive, which is diminish- ing. The incentive amount is calculated for the individual physician, not the practice, and is 75 percent of the phy- sician’s Medicare allowed charges up to a maximum. Physician who practice in a federal health professional short- age area are eligible for an additional 10-percent bonus.
Physicians who choose not to mean- ingfully use an EHR will pay a Medicare penalty: 1 percent in 2015 and 2 percent in 2016, with a cap of 3 percent in 2017 and beyond. There is one caveat to the penalty. If at least 75 percent of office- based physicians do not demonstrate meaningful use by 2018, the U.S. De- partment of Health and Human Services secretary has the authority to increase the penalty an additional 1 percent for the next two years. That could mean a 4-percent penalty in 2018 and a 5-per- cent penalty in 2019. To receive the incentives, physicians
must register for the Medicare EHR in- centive program at
www.cms.gov/eh
rincentiveprograms. Each year of par- ticipation, they also must attest to the Centers for Medicare & Medicaid Servic- es (CMS) to meeting the meaningful use measures; separate attestation pages are required for each measure.
In their first year of participation, physicians must demonstrate meaning- ful use for a 90-day EHR reporting peri- od; in years two through five, they must demonstrate meaningful use for a full- year EHR reporting period. However, in 2014, everyone, regardless of their stage of meaningful use, will be required to demonstrate meaningful use for only 90 days. A physician must be enrolled with the Medicare Provider Enrollment, Chain, and Ownership System (PECOS) to receive the incentives.
Medicaid incentives. The Medicaid program is different in that eligibility is based on patient volume. Medicaid must account for at least 30 percent of the patients seen in the practice, unless the physician is a pediatrician. Pedia- tricians are eligible if the volume is 20 percent.
Physicians must reestablish their eli- gibility each year, basing patient volume on either patient encounters or patient panel for a sample 90-day billing period from the previous calendar year. FQHC or RHC physicians can partici-
Table 1. Medicare incentives: maximum per year. Incentive Payment
2011 2011 2012 2013 2014 2015 — Last payment year is 2016. 50 TEXAS MEDICINE February 2014 — — 2012 2013 2014 2015 $18,000 $12,000 $8,000 $4,000 $2,000 2016 Total paid — $44,000 $18,000 $12,000 $8,000 $4,000 $2,000 $44,000 $15,000 $12,000 $8,000 $4,000 $39,000 $12,000 $8,000 $4,000 $24,000 — — — —
First Payment Year
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