A review of the Medicare and Medicaid electronic health records meaningful use incentive programs finds room for improvement in verifying that providers qualify for incentive payments.

The review of the first year of meaningful use also finds providers often exempt themselves from certain measures--as allowed--and frequently report at least one clinical quality measure based on less than seven patients.

The Government Accountability Office, a congressional watchdog agency, conducted the review. It analyzed Medicare meaningful use attestation data from 2011, reviewed verification processes for four state Medicaid meaningful use programs, and interviewed officials from the American Hospital Association, American Medical Association, HIT Policy and Standards Committees, and a handful of Regional Extension Centers.

The four Medicaid state programs studied--Iowa, Kentucky, Pennsylvania and Texas--have automated prepayment checks built into their databases to verify eligibility. All but Texas also conduct post-payment audits of a sample of providers, and all four states are implementing processes to verify the accuracy of payments made to hospitals. Medicare has pre-payment verification processes and in 2012 is starting a post-payment audit program.

GAO recommends that CMS study increasing prepayment verifications, establish timelines for quickly evaluating effectiveness of audits, collect additional verification information from Medicare meaningful use providers that the agency already suggests Medicaid plans collect, and offer states the option of having CMS collect meaningful use attestations from Medicare providers.

On the issue of providers being able to exempt themselves from reporting on at least one mandatory meaningful use measure, GAO found about 72 percent of eligible professionals and 80 percent of hospitals take the government up on that offer. Professionals may exempt up to six measures and hospitals up to three if the measures are not relevant to clinical practices or patient populations. For example, a majority of providers claimed an exemption from the mandatory measure to provide patients with an electronic copy of their health information because they received no such requests.

Some measures being reported were based on very small sample sizes. An analysis of clinical quality measures found 41 percent of eligible professionals and 87 percent of hospitals reported at least one such measure based on data from less than seven patients. “Clinical quality measures calculated using few payments may be statistically unreliable, which, according to the American Hospital Association and others, could detract from providers’ abilities to use those measures as meaningful tools for quality improvement,” according to the GAO report.

The report, “First Year of CMS’s Incentive Programs Shows Opportunities to Improve Processes to Verify Providers Met Requirements,” is available here.

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