For the first time, physicians and other health professionals received more cash in Medicare meaningful use bonuses than hospitals got in a single month. However, Medicare Payment Advisory Commission data show that the vast majority of physicians have yet to collect a dime of government incentives for their use of electronic health records.

In February, the latest data available, 12,365 physicians and other “eligible professionals” received $222.6 million in Medicare meaningful use incentives, compared with 84 hospitals getting $129.9 million, according to an April 5 report delivered to MedPAC.

Doctors qualifying for Medicare meaningful use incentives in stages over five years can earn up to $44,000 per physician. Hospitals’ incentive terms can vary, but they start with a $2 million base payment. The number of physicians and other professionals qualifying for meaningful use in February, and the amount of incentive money they collected, was about equal to their participation and bonus numbers in December 2011 and January combined. Meanwhile, hospital totals have dropped since peaking at 193 facilities and $374.7 million in bonuses in December 2011.

Joseph Kuchler, spokesman for the Centers for Medicare & Medicaid Services, said the organization is pleased with both the growing number of registrations and the number of physicians qualifying for incentives. Physicians began receiving Medicare meaningful use bonuses in May 2011. The bonuses were created by a provision in the 2009 economic stimulus package.

“We actually anticipated a somewhat slower start due to providers needing to both acquire and implement their certified EHRs, and because it was really the earliest adopters we saw being paid through mid-2011,” Kuchler said.

The CMS-produced April 5 report, delivered at a MedPAC meeting in Washington, showed that more physicians and eligible professionals were collecting Medicaid meaningful use bonuses, but at smaller numbers than the Medicare program.

In February, 4,920 physicians and eligible professionals collected $103.3 million in Medicaid meaningful use bonuses. Those numbers have risen every month since Medicaid incentive payments were first available in January 2011. Meanwhile, 172 hospitals collected $140.8 million in Medicaid incentives, down from a peak of 347 hospitals collecting $289.1 million in December 2011.

For Medicaid, physicians can receive as much as $63,750 over six years. For hospitals, the incentive terms are similar to what they can get under the Medicare meaningful use programs. Hospitals, but not physicians, can participate in both the Medicaid and Medicare programs. The Medicaid meaningful use program, like Medicaid itself, is offered by the states. CMS said 38 states have made bonus payments as of February, and five others were participating but have not yet paid anything.

In its meeting, MedPAC reviewed only the Medicare meaningful use numbers. Commissioners questioned whether some physicians and critical access hospitals will qualify in time to receive the full amount of incentives and avoid penalties, according to transcripts from the committee meeting. Doctors must adopt EHRs and achieve meaningful use criteria by October 2014, or else they would see reduced Medicare or Medicaid payments in 2015.

Overall, only 35,341 physicians and eligible professionals have collected Medicare meaningful use bonuses, totaling $636.2 million. The CMS report said 796 hospitals have received $1.4 billion in bonuses. In the Medicaid program, 24,332 physicians and eligible professionals have collected $510.8 million in meaningful uses bonuses, and 1,559 hospitals have received $1.3 billion.

The report said those who received money accounted for 16% of hospitals and 6% of eligible professionals, including physicians, nurse practitioners, dentists and chiropractors who are not employed by a hospital.

“I don’t know about you all, but I’m somewhat disappointed by the participation both by the hospitals and the physicians, especially when we have the carrot and the stick approach,” said Ronald D. Castellanos, MD, a MedPAC commissioner.

MedPAC Commissioner George Miller Jr. said that although the reimbursements are good, up-front technology costs have kept many from making the needed investments. He questioned whether the low numbers should be dealt with from a policy perspective.

But Zachary Gaumer, senior analyst for MedPAC, expressed optimism that more incentives will go out, based on the number of physicians and hospitals that have registered for the Medicare meaningful use program. He said 66% of hospitals and 25% of eligible professionals in the U.S. have signed up to participate. As of February, 125,321 physicians were registered for the program. Any physician or hospital wishing to receive a bonus must prove to CMS that its EHR systems meet meaningful use criteria through a process called attestation.

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