Despite all of the buzz surrounding the creation of this legislation, its impact on medical practices should be minimal. The Economic Stimulus Package offers a limited financial incentive to physicians who purchase a “government EMR.” To qualify for the government’s offer, practices will have to purchase the type of EMR which history has shown to be unusable, costly, and a drain on productivity, and will then have to endure the inevitable protracted implementation process. Then, before receiving each (or any) of the portions of the promised funding, the physician will have to demonstrate to the government that he/she is using the EMR in the way and to the full extent demanded by the Department of Health and Human Services. Physicians stand to gain at most $44,000 by participating in this program, or an average of $8,800 per year, but risk losing considerably more in productivity, efficiency and quality of patient care, as well as capital. There are better opportunities available elsewhere to achieve a much higher financial return as well as other benefits.
The following are a few facts about the legislation for you to consider:
1) There is no government requirement to purchase EMR technology.
This is a voluntary program only. The government is not requiring physicians to purchase an EMR of any type, “certified” or not. The law specifically states: “…nothing in such Act or in the amendments made by such Act shall be construed to require a private entity to adopt or comply with a standard or implementation specification adopted under section 3004.” [Sec.3006 (a) (1)] The program is purely optional, offering a relatively small incentive payment to those who can comply with the onerous and continually evolving requirements. Therefore, practices should feel free to purchase the product which they feel delivers the greatest workflow benefits to its physicians and improves patient care, rather than letting the government make this important choice for them.
2) $44,000 in “potential” incentive payments pales in comparison to the cost of purchasing an EMR/EHR which is expensive, difficult to implement, and not easily adoptable.
The $44,000 is not awarded at the time of EMR purchase, but rather is paid out over 5 years, (averaging $8,800 per year), beginning in 2011 as follows, contingent upon demonstration of “meaningful use:”
- Year 1: $15,000 or $18,000
- Year 2: $12,000
- Year 3: $ 8,000
- Year 4: $ 4,000
- Year 5: $ 2,000
The types of EMRs that are designed the way the government wants, i.e. traditional, point-and-click EMRs, do not have a track record of success. Historically, only 50% of the implementations of traditional EMRs have resulted in successful adoption and the literature and blogs are replete with testimony from disillusioned and frustrated traditional EMR users. The reasons have been repeatedly documented in studies by well-respected institutions:
- A U.S. government-funded study by the MGMA reported a decrease in physician productivity of up to 15%.
[http://www.srssoft.com/pdf/MGMA_Landmark_Study.pdf] - According to The National Research Council, existing EMRs cause inefficient workflows, clinicians spend more time entering data than using it, meaningful interoperability is almost non-existent, and benefits are significantly less than anticipated.
[http://books.nap.edu/openbook.php?record_id=12572&page=R1] - In the New England Journal of Medicine, renowned physicians and Harvard professors maintain that EMR technology diverts the physician’s attention from the patient and creates chart notes in a way that is seriously flawed. [http://www.srssoft.com/pdf/NEJM_Avoiding_Pitfalls_of_Going_Electronic.pdf]
- In 2008, the Congressional Budget Office released a study which claimed that “office-based physicians may see no benefits [from traditional EMRs] and may even suffer financial harm.”
[http://www.cbo.gov/ftpdocs/91xx/doc9168/05-20-HealthIT.pdf]
The government has created this legislation without the benefit of any comparable studies to demonstrate the value and effectiveness of traditional EMRs in accomplishing the lofty goals itemized in the “purpose” section of the Act. When you factor in the physician’s costs related to the purchase, lost productivity, tedious and risky implementation, and effect on patient/physician relationships of this type of EMR, $8,800 per year is trivial. The full burden of risk sits squarely on the shoulders of the physicians. Purchase a “government” EMR and find it unusable, then what?
3) Policy recommendations regarding the implementation of nationwide healthcare IT will be made by a large committee that includes only one practicing physician.
Of significant concern is the issue of who is going to be designing the “government” EMR. The legislation assigns this responsibility to the Health Information Technology (HIT) Standards Committee, a group of varied stakeholders, only a small minority of whom will be “providers.” The Standards Committee is to be established by the HIT Policy Committee, a group with a membership of over 20 mostly political appointees, only one of whom is a physician. Can these committees be relied upon to represent the best interests of practicing physicians?
4) Incentive payments are not guaranteed and the risk is entirely borne by physicians; if you cannot show “meaningful use” the way the government demands, you will not qualify for any incentive payments. The government is trying to encourage the purchase of a “government” EMR through a conditional “IOU.”
If you do purchase a “certified” EMR but find that you are unable to demonstrate “meaningful use” of all of the required functionality to the extent demanded in any of the 5 payment years, you forfeit the incentive for that year. To compound the issue, the Secretary of HHS is charged with revising the standards to become more stringent over time. According to a study published in the New England Journal of Medicine, only 4% of physicians are currently able to make full use of an EMR. Given this track record, the purchase of a certified product by no means guarantees receipt of the incentive.
The hybrid EMR will give you what the Stimulus Plan won’t—easy-to-use software that works! Manage your practice more efficiently, increase physician productivity, enhance revenue in many other ways, and get your money from the government painlessly through ePrescribing. Rewards without risk.
Related posts:
Will payment be one payment for entire group or individual physician?
We just purchased an EHR July 25, 2008. Have we missed the boat, or can we still qualify? We will be paying for it for quite some time.
In response to Jim Moore’s question, the incentive payment is per physician.
In response to Kristi Dozier’s question, the first incentive payment year is 2011. It appears from our reading of the legislation that physicians with existing EHRs will be considered for the payments as long as their EHR meets the government’s criteria for certification, which are yet to be determined, and that they are able to successfully demonstrate “meaningful use,” also not yet defined.
We have had an EMR for a little over a year, would we qualify for any of these funds?
Bill Walker’s question expresses a concern common to many physicians who already have an EMR. Please see my response above to Kristi Dozier (#4). Now that the bill has been signed and is being posted, we will see if we can find any further details about existing EMRs.
Multiple Physicians practicing under 1 office will each receive there own rebate? Even if they are only sharing 1 EMR system between them?
In response to James Hart’s question, the incentive payment is per physician.
Shame on you for spreading dis-information. The whole purpose of encouraging physician practices to install and use an “interoperable EHR” is to reduce medical errors, avoid drug/drug & drug/allergy interactions and reduce unnecesarily repeated tests and the costs associateds with these. This is done by providing citical information to ERs and other points of service when and where they need them.
If the information is locked up in a “hybrid EMR” in the practice office it is no better than the paper chart.
I would suggest that, rather than fighting this trend, SRS work to transform their products into ones that can participate in the information exchange program now going forward.
Ron Mitchell
Healthcare CIO
To Ron Mitchell,
Thank you for sharing your thoughts. The goals of the incentive program are indeed admirable, however they will not be met by requiring the type of EMRs that physicians have traditionally found to be unusable. The SRS hybrid EMR enables physicians to increase the quality of care they provide, but in a manner designed to increase their productivity, allowing them to provide this enhanced care to a greater number of patients. The only “trend” that SRS is fighting is the trend toward adoption of EMR systems that are unusable and negatively impact physician productivity. Of what value is an EMR that has all of the government’s desired features if it is deemed unusable by physicians?
The hybrid EMR does what the government wants, but not in a way that costs the physicians time and money. Included in “meaningful EHR user” are the following:
1) ePrescribing: SRS has an easy to use ePrescribing module, which far surpasses the capabilities, usability and design of ePrescribing in what will likely be the “government” EMRs. SRS reduces prescribing errors, allows physicians to check for drug-to-drug and drug-to-allergy interactions, and facilitates the sharing of Rx data with other providers.
2) Exchange of information: Information is not “locked-up” in our hybrid EMR. The hybrid EMR has the ability to share data; our clients have done so with local RHIOs.
3) Reporting: SRS has an extremely robust data and reporting capability. In contrast to “government EMRs,” it is structured on the premise that the measures that are important to report should be determined up-front, and then data entry can be limited to those data, rather than requiring physicians to spend time entering all possible data through a cumbersome, time-consuming process (which experience has shown, tends to be abandoned quickly because of its onerous nature). SRS users who have chosen to do so have been able to provide all data required to take advantage of PQRI and other P4P programs.
If future government definitions of “EMR” allow physicians to be productive to the point where the productivity gains outweigh the costs (financial and operational) of adopting and using the systems, then SRS will tailor its hybrid EMR to meet the government’s standards.
What exactly is a “government EMR” ?
Have they developed there own program already? I thought the ONC is setting up standards for current or future EHRs to follow?
I believe this Act will be in your company favor as long as you comply to whatever set of standards they come up with.
In response to James Hart’s question, we are using the term “government EMR” to describe the EHR systems that the government will define as the systems you must “meaningfully use” if you want to be considered for incentive payments. No one knows exactly what the “government EMR” will look like, because as you pointed out, the initial set of criteria are yet to be defined by a committee, which is yet to be appointed by the National Coordinator, David Kolodner.
There are several issues of concern regarding the criteria and how they are to be established:
• The HIT policy committee will be made up of well over 20 people, only one of whom must be a practicing physician. It is therefore unlikely that their decisions will be in the best interest of busy medical practitioners.
• The Secretary of HHS has been given a deadline of Dec. 31, 2009 to accept an initial set of standards. Given the short timeframe, not to mention the absence of a Secretary at the current time, it is likely that the government will simply adopt and possibly strengthen existing CCHIT standards. These are the standards underlying many existing EMRs, and those EMRs do not have a track record of success.
• The criteria are going to become more stringent over time, first because of the point above, and second because the legislation charges the Secretary with making them so. Therefore, what is defined as a “government EMR” for the early years of the program will not meet the criteria in the latter years without substantial modification. In a webcast today, the CEO of HIMSS advised physicians who want to try for the incentive payments to build guarantees into their contracts with vendors for just this reason.
To your last point, what’s good for our company is what’s good for physicians. The success of SRS has been based on providing solutions that physicians find usable and helpful in their efforts to provide the best patient care in the most efficient manner.
If we have been on a CCHIT certified EHR for 10 years. Now want to add modules such as e-prescribing, electronic encounter forms, order entry, etc. Will we still be eligible for the full $44,000 for each physician (does physician also denote Non-Physician Providers as well)to allow us to upgrade our software and hardware, some of which is sorely out of date? Would any balance up to the $44,000 maximum be available to reimburse for some of our previous expense in implementing and training our existing EHR?
In response to Pam Hennigan’s comment, the $44,000 is an incentive for use of a certified EMR; it is not reimbursement for the costs of purchasing an EMR nor upgrading an existing EMR. To qualify for the incentive payments, you will first need to make sure that your EMR meets the government’s criteria, and then on an annual basis, physicians must demonstrate “meaningful use” of the EMR. What they will have to do to prove this is yet to be determined.
As for who can receive incentive payments, Section 4101(a)(0)(6)(C) of the legislation limits “eligible providers” to physicians.