Meaningful Use Penalties Hurt Patients Too

Two physicians say that Medicare reimbursements not only hurt physicians, but also damage patient relations and care as well.

Starting in 2015, eligible providers who are not yet "meaningful users" will be hit with a 1 percent penalty on their Medicare reimbursement, increasing annually to 3 percent in 2017.

The American Academy of Family Physicians has long lobbied for the abolition of punitive policies, and the AMA reports on its website that it continues to advocate strongly for making the EHR Medicare and Medicaid Incentive Programs more workable for physicians, "… by asking CMS to establish more reasonable reporting requirements, measurement thresholds, and overall flexibility so that all physicians who want to participate are able to do so."

Unless and until that happens, however, Donald Fordham, a family physician in Demorest, Ga., worries the penalties associated with meaningful use may ultimately hurt patients. "If you're going to be penalized for taking Medicare patients, what's the dynamic force that becomes active?" he asks. "You stop taking Medicare patients because you're going to be doing the same work and getting paid less. It is going to impair access to Medicare and it's not the patient's fault. They didn't ask for this."

Fordham, who is pushing for penalty relief with the help of his state congressional representative, is a solo practitioner who opted out of meaningful use in 2013 due to the cost involved - after successfully attesting to Stage 1. He faces tough choices in the years ahead, including whether to stop accepting Medicare altogether, or join a group practice with pockets deep enough to help him comply with meaningful use standards. "I would like to stay in small practice," says Fordham. "We have physicians in our area who have already stopped taking Medicare patients and that's a consideration I need to look at making five years down the road."

Dale Gray beat him to it. The internal medicine specialist in Rockford, Ill., notified patients in 2009 that he would no longer accept Medicare. At the time, elderly patients covered by the government health insurance plan comprised 50 percent of his scheduled patient visits, but represented just 20 percent of his revenue. Roughly one-third of his Medicare patients chose to stay with his practice and pay out of pocket. But he's since had a change of heart. "I found over the last six years, that there's a subset of those patients who struggle to even pay the $59 I charge for a 20-minute office visit, so I end up seeing them for free," Gray says. "Or, I charge them for a shorter visit to give them a break."

Worse, he found, many of those same patients put off necessary office visits to avoid the expense, or ask for "telephone medicine" instead of coming into the office, which is not conducive to quality care. For the sake of his existing patients, Gray says, he's going back to Medicare, but he still doesn't plan to let new Medicare patients through the door. He's also prepared to collect less than full fare, as he has no intention of attesting to meaningful use. "I never began the process of attesting for meaningful use," he says. "I don't plan to start trying now either, since I don't feel it's worth the effort for the marginal increase in revenue."