Niagara Syndrome and the EHR Incentive Program

"Failure to plan is planning to fail."

The first I heard of the The Niagara Syndrome was from Tony Robbins.  The syndrome occurs when one can be metaphorically described as floating down a river and simply going with the flow without too much regard for where the current is heading - only to suddenly find oneself ten feet from the top of Niagara Falls in a boat with no oars and then saying, "Oh, shoot!".

The looming waterfall in my mind is the penalties, or "Medicare payment adjustments", that will begin in 2015 for professionals who are eligible for the Medicare EHR Incentive Program but who have not adopted Certified EHR Technology and achieved Meaningful Use.  Professionals who have already achieved meaningful use for 2013 will not be subject to the 2015 penalty, but must continue to achieve MU to avoid penalties in future years.  It's not yet too late for professionals who are not yet meaningful users, but time is running out quickly.

The carrots are about to turn into sticks.  Although there's been ample publicity about the program, I know that many providers aren't fully aware of the details.

There are some peculiarities in the program that pertain to those EPs that will be entering the Medicare EHR Incentive program in 2014, i.e. achieving meaningful use for the first time.  For these first-timers, in order to avoid the 2015 penalty, they will have to:

• Adopt 2014 Certified EHR Technology
• Achieve Meaningful Use for a 90-day period
• Attest no later than October 1, 2014.

EPs who have done all of this will be eligible for an incentive payment up to $12,000 and will avoid having their Medicare fees "adjusted" in 2015 and 2016.

A slightly different scenario would be where the EP cannot meet the October 1 deadline but instead:

• Adopts 2014 Certified EHR Technology
• Achieves Meaningful Use for a 90-day period by December 31, 2014
• Attests no later than (presumably) February 28, 2015

In this scenario, the EP would be eligible for an incentive payment up to $12,000, would be subject to a 1% Medicare fee schedule adjustment in 2015 (i.e. would get an incentive AND a penalty), but would not be subject to a penalty in 2016.

In both of these scenarios, continuing to be a meaningful user in 2015 and 2016 would make the EP eligible for additional incentive payments of $8,000 and $4,000 respectively, and  would protect the EP from penalties in 2017 and 2018.

In contrast, let's say that the EP does not become a meaningful user in 2014 but does successfully do so in 2015.  In this scenario, the EP would receive no incentives whatsoever.  The EP would also be subject to a 1% Medicare fee schedule adjustment in 2015 and a 2% adjustment in 2016 before getting relief in 2017.

That's a pretty big difference, especially for primary care providers who see a lot of Medicare patients.  My fear is that a significant number of those EPs won't realize that they're about to go over the falls until late in 2014, by which time it will be far too late for anyone to pull them to shore.