Wading Through Meaningful Use Confusion

In our last blog we outlined the nuts and bolts of the overwhelming changes facing physicians. But the question remains: What does this really mean? What should I expect and what should I ignore? No single blog entry can cover all of the effects, but there are a few things you should definitely be aware of.

For one, with the passing of the American Recovery and Reinvestment Act of 2009 (ARRA), physicians—that’s you folks—may earn incentives up to $44,000 from Medicare for implementing electronic medical records that meet meaningful use criteria—that’s us. After 2015 however, practices can be penalized if they fail to meet these, and other, criteria. Two of the three cornerstones of ARRA are ePrescribing (also called eRx) and reporting, but physicians face additional regulations to which they need to comply; in addition to the EMR we mentioned above, physicians must fulfill MIPPA (Medicare Improvements for Patients and Providers Act) ePrescribing and PQRS (Physician Quality Reporting System) requirements. Once called PQRI—the ‘I’ for ‘initiative’—policy makers for some reason decided on a more alphabetically inclined acronym.

Unfortunately, there are a myriad of inconsistencies in the programs. For example, physicians cannot receive an EMR and an eRx (MIPPA) incentive in the same year, yet they can for EMR and PQRS incentives. Also, because eRx criteria differ under MIPPA and ARRA, a physician could fill requirements for one and not the other. Furthermore, whether or not a physician receives incentives under ARRA, s/he must comply with MIPPA eRx requirements (namely, G-Coding, which is not a meaningful use requirement), to avoid penalties of 1%.

To add even more to the confusion, though some meaningful use and PQRS measures are the same, separate reporting is required. And the reporting periods and measurability of them differ as well. What a pain—fortunately, the AMA is recognizing that. It recently distributed a survey to various physicians for their input on the regulations that will inevitably increase their administrative costs and paperwork burden, or that outright interfere with patient care. And at the end of February, the Government Accounting Office recommended that the CMS eliminate overlapping eRx standards.

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