The publication of the anxiously awaited final rule on meaningful use was announced Tuesday at a press conference featuring a cast of dignitaries. HHS Secretary Sebelius; newly appointed head of CMS, Donald Berwick, M.D.; ONC head David Blumenthal, M.D.; and Surgeon General Regina Benjamin, M.D. unanimously and vociferously extolled the virtues of a paperless medical practice. I could not agree more, as I’ve stated in prior EMR Straight Talk posts. Where we disagree is in considering the impact on physician productivity and revenue. There was not one mention at any point during this “EMR pep rally” of the impact on productivity that is associated with pursuing meaningful use.
Uncertainty has been removed from the market, and the most common excuse for inaction is now gone. The government’s intentions are crystal clear, and physicians know exactly what will be required if they want to pursue the EHR incentives. Physicians who want to become digital and reap the extensive benefits of a paperless office must now make a choice—pursue the productivity path or follow the meaningful use path.
As expected, most of the initial response to the release of the rule involved identification and analysis of the differences between the proposed rule and the final version. For those of us who have followed meaningful use closely for the past year and a half, this is an interesting topic of conversation, but for physicians, the only relevant issue is what the current requirements mean to their practice—how would they respond if this was the first they ever heard of meaningful use? The sheer length of the rule (864 pages) will no doubt raise valid concerns regarding the complexity and challenges involved. Physicians must take the time to read the matrix of objectives and measures for themselves to estimate the impact on their time that trying to demonstrate meaningful use will have. The data collection and reporting requirements are significant, and they will become even more so in Stages 2 and 3. High-performance physicians/specialists, in particular, will find that the cost of lost productivity far outweighs the potential incentives.
In pursuing the meaningful use path, productivity will be affected not only by the meaningful use requirements, but also by the very nature of the type of EMRs that must be used to successfully satisfy the measures. Historically, point-and-click EMRs have been rejected by high-performance physicians because, by design, they focus on data collection and note creation rather than on usability and physician productivity. Nothing has really changed in this regard, and I don’t foresee a sea change in physician behavior resulting from the promise of a potential $44,000.
But the waiting is over, and the time has come for physicians to choose their EMR path.
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I continue to believe that the incentives, $44,000 over 5 years, are not an appropriate motivation to move to an EMR of any kind. Please, I hope no one is moving down this path in hopes of capturing all, or any, of the incentive revenue. In my practice, that equates to .2 extra patients/day over the 5 year period. Unfortunately, that small amount of increased volume will not be possible, in fact it will be I fear, quite the contrary. Our transition to an EMR is likely to be as recently described to me “a bloodbath for primary care”.
As Evan has said after the great fight it’s time to put up or shut up. Most specialty groups luckily are very intelligent and have intelligent people working for them that recognize the stupidity of this law. Don’t blame Obama for this, blame both parties to allow this type of legislation to be passed. I do hope you are of the majority in the coming months that will be voting against anyone that voted for medical reform and maybe someday we can get back sanity in our national arena. Oh, and just to make it perfectly clear since I mentioned Obama. I didn’t vote for him.
As a consultant in the healthcare services for the past 20 years, I have seen a constant eroding of quality of patient care for the need of quantity of patients processed. This pushed on by the constant decreasing reimbursment for services. This new law is a definite path to rationing of healthcare services. No EMR system will change this. The complex communicating and diagnostic systems will not be resolved by the Big Computer in the CLOUD. We continue to give up privacy and this law is a new step toward more of the same. I also hope that voting out all of the dems sill helps repeal this law. I saw this coming but my NO for Obama was not enough.
Cathy, you don’t think that with more insured people, your patient volume will not increase by at least 2 patients per day? That’s the idea of the EMR stimulus – to help physicians handle the massive influx of patients that is coming. I would imagine that you will see an increase greater than 2 patients per day within a few years, but I obviously know nothing about your personal practice. All medical offices need more efficiency for what is coming, though, whether you agree with the healthcare reform or not.