EHR Incentive Program Financed on the Backs of Physicians

I was shocked to read the following paragraph, buried on page 379 of the 455-page Proposed Rule for Stage 2 Meaningful Use, (page 13812 in the Federal Register). The paragraph also appears verbatim in the Final Rule for Stage 1:

Explanation of Benefits and Savings Calculations:

In our analysis, we assume that benefits to the [EHR Incentive] program would accrue in the form of savings to Medicare, through the Medicare EP payment adjustments [penalties]. Expected qualitative benefits, such as improved quality of care, better health outcomes, and the like, are unable to be quantified at this time.

While the second sentence is disappointing, I do respect CMS’s candor in acknowledging the ongoing paucity of hard data on the quantification of the assumed qualitative benefits of EHR adoption. The first sentence, however, left me short of breath because it points to the following inescapable, disheartening conclusion: The economics of the EHR Incentive Program is predicated upon physician failure!

EHR Incentive Program Financed on the Backs of Physicians

In fact, the government’s projections for physician participation from 2014 through 2019 are rather pessimistic. Meaningful use among Medicare EPs is estimated to grow, in the less optimistic (“low”) scenario, from 18% to a mere 36%, and in the most optimistic (“high”) scenario, only from 49% to 70%.¹ Even these high projections are low enough—incidentally—to give the Secretary of HHS the option to increase the penalties from the statutory 3% in 2017 to a potential 4% in 2018 and 5% in 2019.

What kind of program have we created that over a period of 9 years will likely take almost as much money from physicians as it gives them?

The government giveth and the government taketh away!

¹Source: Proposed Rule, Stage 2 Meaningful Use, page 13804, Table 19.

7 thoughts on “EHR Incentive Program Financed on the Backs of Physicians

  1. Evan,

    Thanks for sharing, I too feel disappointed by what you have discovered. The people that have justified or have presented the savings with Meaningful Use and EMR have hyped and misrepresented the savings to support their conclusions. That is exactly Murphy’s Law #12 – enough research will support your conclusions. As I read articles from medical facilities that have implemented EMR they too are projecting tremendous savings yet to be realized. We don’t really have a choice but to install EMR systems but in my opinion we have only scratched the tip of the iceburg. We will be constantly making changes, spending money, trying to meet new/revised requirements and never reach the end result. We will continue to pay taxes so the government workers will have jobs to make the lives of physicians and especially small practices continually in a state of anxiety and stress. It will never end. Thanks again, Jack

  2. I don’t see how you think that the money taken will be from the physicians who have complied with the regulations and have an EMR which will make their documentation of each patient more complete than the paper charts we had forever. Those who chose to keep doing what was done since time began are the ones who would be paying the penalties, so if ALL physicians comply, there will be no penalties and the money will have to come from stopping wars and other nonhumane expenditures.

  3. Do you realize nearly every post you publish has a negative theme? Why not write something positive for a change? Then maybe I wont unsubscribe from your blog…

  4. I do agree that from a clinicians perspective you will be able to provide better patient care. But, there are some other not so obvious concerns that I have. A couple of things come to mind immediately. One is that physicians are going to be totally liable for unauthorized breaches of patient PHI. Currently the Office of Civil Rights is in the process of conducting 150 audits in 2012 of small practices, hospitals, and other medical facilities. If you transmit your PHI on a patient to a business partner and they in turn breach or allow the PHI to be leaked, you are held responsible and subject to fines and penalities. Fines can begin or start around $1000 per patient, which in TriCares violation is in the millions of dollars. I am coming from the back end of the installation of Meaningful Use, HIPAA, and breaches of PHI, Breaches and the subsequent fines are being considered as income to the government. The transition from ICD-9 to ICD-10 is going to impact physician productivity as well. It will also impact your support staff’s productivity too. Documentation required for reimbursement is going to be increased and require more precise – thousands of more diagnosis and CPT codes. Reimbursment will be delayed as well so physician practices should start setting aside funds in a cash reserve to help carry them through this delay as well. It also behoves physician practices to start immediately to streamline their practices for these coming events. I am not opposed to EMR but an advocate because it will improve the quality of patient care but it is going to cost physician practices to get this done. In my opinion we are in the early stages of a “healthcare evolution” but there is also going to be pain and suffering to get there too. I am trying to help small physician practices streamline for the future so they will be in a better position operationally and financially to meet this challenge.

    Many large healthcare systems have already suffered severe penalties for breaches and they are listed in what is called the “Hall of Shame”. I’m sure you would recognize many of them on the list plus they also have huge financial penalties. I read today where a small physician practice paid out in fines of $100,000 for a breach in patient PHI.

  5. The payer’s purposes in pushing EMR’s are to allow eventual remote data mining of our records so as to allow the payers to interfere more in our medical decision making to save themselves money, and also to make te payer’s job easier in audting, veriying visit complexity and coding, etc. by shifting more of that work to us.

    The increased cost of EMR infrastructure over years, plus the inefficiency of the EMRs compared to paper records in patient flow, means that many of us will stick to paper records and they can make money by fining us.They probably figure correctly that the loss of clinic revenue caused by EMR meaningful use will drive us not to use them and so allow ourselves to be fined.

    If as Dr. Huheey says, you do comply, I don’t see how they would get that money directly from you either, but then they can make money by more easily pushing you to cheaper meds and less procedures as they monitor your decisions.

    I’m just using paper 5 more years then I retire.

  6. We tried an EHR after a fairly extensive process of evaluation. The product seemed well received. It lasted in our office about 10 days. We all hated it. Having gone through the process of implementation, training and use did provide a useful benefit. It gave me much greater insight into understanding the limitiations of EHRs and what I might use if we tried again.

    There is no real data to show what real benefits will be seen with the adoption of these myriad of EHR products that are not compatible. Trying to describe what previously was easy with an english sentence was a misery with the drop down boxes and various check boxes. The inefficency was unbelievable.
    So I think that we have made the decision to take our lumps and hold off on EHR for now. I suspect many others will do so also. Therefore the government will have a nice pile of money “saved” by penalizing those of us that don’t want to go on the EHR bandwagon.

    The sad thing is that I really think that the health care system is badly broken with so many uninsured people not having proper access. In this county if you lose your job you may lose your life. (I saw this happen to a 45 y old diabetic) So we need some sort of reform. The bill passed has a few very fine features like allowing coverage for pre existing illness.

    One of the hospitals I am on staff at has sent out a notice that we have to have a mandatory four hour course on getting along and some other nonsense. This top down bureacratic control is slowly becoming more invasive and bothersome. Sure makes retirement more enticing.

  7. Dr. Huheey’s pollyanna attitude to this process is what is wrong with US physicians today. They seem to think that CMS and insurance companies are attempting to improve patient care, and don’t seem to mind abandoning their professional autonomy and “comply”. The true goals of these entities are, in fact, reducing their costs, increasing their control over the doctor-patient relationship, and shifting all financial and legal risk of implementing these changes to physicians. Physician staff in large institutions, as well as the upper echelons of the AMA, seem the least concerned with this developing scenario.

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