Fate of MU incentives unclear when providers change job sites

By Dawn Nee
08:15 AM

As a child on the playground at recess the rules were simple, “finders keepers, losers weepers.”  And everyone has heard the saying “possession is 9/10ths of the law.”  But with Meaningful Use EHR incentive dollars for eligible providers, figuring out to whom the money belongs is not so simple.

Many physicians are abandoning private practice and becoming employed by hospitals and health systems. There also seems to be a trend whereby employed physicians, if unsatisfied with their employer, will move on to jobs at a different practice or health system. But since the EHR incentive program is based around individual physicians, all of a provider’s meaningful use baggage moves right along with him or her to the next practice.   

For example, an employed physician terminates employment with health system A in October 2013 and gets a job as an employee with Health System B. Her reporting period for Stage 1 Year 2 is 1/1/2013 – 12/31/2013. Who should get the incentive payment?

For either health system to attest, cooperation would be required to share the Meaningful Use data, so that her attestation would correctly reflect the entire reporting period. Additionally, this is all complicated further, due to the tie-in with PECOS and the EHR incentive program. The payee for a physician’s Medicare payments with PECOS must match the payee that is selected in the registration process for the EHR incentive program. If there is not a match, the attestation will be rejected.  

I realize this will be a short-lived problem, as the incentive part of the EHR incentive program is slowly dwindling, but it is a challenging problem that many organizations currently face. It seems as though the right answer is to discuss the issue during contract negotiations to determine what should happen with the money. Logic would indicate that the money be split based on the amount of time the physician worked in each location. However, at a time of declining reimbursements and high overhead for a medical practice, there seems to be a lack of willingness to share.

The new employer has  “possession is 9/10ths of the law” working in their favor, because they are the payee for Medicare payments and that is where the Meaningful Use check will be sent. However, the new employer still requires cooperation from the former employer to receive the MU data from the prior employer’s EHR system. It will be interesting to see what happens when one of these physicians is audited for Meaningful Use. At that point the two employers would need to work together to respond, and if the money is taken away, from whom will it be taken?

Thus, even as we try to simplify and improve the quality of healthcare, we seem to end up making things more difficult. The complications continue.