Physician participation in the CMS Physician Quality Reporting System (PQRS) and Electronic Prescribing Program grew 47% from 2012 to 2013, according to a federal report released late last week. In addition, more than 460 million doctors declined to sign up for the programs, subjecting themselves to nearly 2% Medicare payment rate cuts as a result, report authors said.

The news could provide a jolt to any long-term care providers mulling new electronic health record implementation rules. Those using incompatible or uncertified EHR systems by the end of 2018 could face reduced Medicare reimbursements under a bill introduced in late March in both houses of Congress.

More than a million participating physicians received more than $382 million in so-called incentive payments from the PQRS and e-prescribing programs in 2013, according to the CMS report. Among the 460,000 physicians who opted out, nearly half treat 25 or fewer Medicare beneficiaries a year, according  to CMS. Sixty-five percent of PQRS eligible general practitioners failed to participate in the program or meet its requirements, Modern Healthcare reported.

Medicare quality improvement program participants who aren’t meeting meaningful use requirements for EHR systems could face penalties as early as this year.