The Gold Not Taken – Meaningful Use Tale of Woe

By Jim Tate, EMR Advocate
Meaningful Use Audit Expert
Twitter: @JimTate, eMail:

Life is full of missed opportunities. As we age the list of “what ifs” grows longer. What if I had been brave enough to ask out that girl that set in front of me in 9th grade Economics? What if I had made more life decisions with a balance of both mind and heart? I don’t know if I’ve learned much, but there is one thing I now know: When life reaches out with a gold ring, reach back.

Nowhere is this more apparent than a meaningful use tale of woe I heard last week. The hospital met the meaningful use requirements in 2011, attested, and received a Year 1 incentive over $1,000,000. Based on the algorithmic factors that go into calculating hospital incentives, their 2012 incentive would have been over $800,000. They met their Year 2 full year meaningful use requirements, but did not attest. You read that right, THEY DID NOT ATTEST. That’s right. There is a deadline for each year’s attestation submission of meaningful use and it was not done. Who knows why it wasn’t done? Was there a change in staff, pressing priorities, gap in responsibility, demonic forces? Who knows? They may not ever get to the bottom of what happened.

After the effort of implementing an EHR, modifying work flows, and getting everybody onboard one final critical step was not accomplished. They simply did not go online, attest, and ask for the incentives. Over $800,000 was left on the table simply because it was not picked up.

The bad news is written in stone in the Final Rule: “As discussed above, however, for the Medicare program, the failure of the eligible hospital or CAH to demonstrate meaningful use in the subsequent year, will affect the total payments that hospital is eligible to receive, as, pursuant to the statute, the hospital is treated as skipping a payment year.”

There is probably more than one moral to this story, I’ll let you take your pick. In the world of comedy and tragedy this warning falls into the camp of the latter. May we all offer a moment of silence to the tragedy of opportunities missed, girls not asked out, and golden rings not seized.

Jim Tate is known as the most experienced authority on the CMS Meaningful Use (MU) audit and appeal process. His unique combination of skills has brought successful outcomes to hospitals at risk of having their CMS EHR incentives recouped. He led the first appeal challenge in the nation for a client hospital that had received a negative audit determination. That appeal was decided in favor of the hospital. He has also been successful in leading the effort to reverse a failed appeal, even after the hospital had received notification of the failure with the statement, “This decision is final and not subject to further appeal”. That “final” decision was reversed in less than a week. If you are a hospital with questions or concerns about the meaningful use audit process, contact him at: