Government Health IT Push Encounters Some Hard Realities

(MoneyWatch)  So you thought that a $34 billion subsidy would be enough to get America's doctors to adopt electronic health records? Think again.

Virtually the entire medical establishment has criticized the Administration's approach to disbursing the money, which requires physicians to vault a series of hurdles collectively known as "meaningful use" of EHRs. And while those requirements were intended to prod doctors into improving the quality and efficiency of care, they are discouraging many physicians from plunging into information technology.

In a letter to Charlene Frizzera, acting administrator of the Centers for Medicare and Medicaid Services (CMS), the AMA and 95 state and specialty medical societies said the "aggressive" criteria for getting government subsidies will deter many physicians from adopting EHRs. The societies urged CMS to abandon its "all-or-nothing" approach to qualifying for EHR incentives.

The Medical Group Management Association (MGMA), which represents groups that include 275,000 physicians, said that physicians were being required to perform functions -- such as the ability to exchange clinical summaries with other providers - that EHR vendors are just in the process of adding to or testing in their products. Moreover, MGMA said, some of the criteria for meaningful use depend on the cooperation of outside parties.

For example, the electronic prescribing requirement relies on the ability of pharmacies to receive scripts online, and the ability to receive lab results electronically depends on the willingness of national, regional and hospital labs to build interfaces with EHRs. As a result of these and other problems, MGMA expects a "significant percentage" of physicians who purchase EHRs will fail to win government subsidies.

MGMA suggests delaying for a year the deadline for showing meaningful use of EHRs to get the full incentives. And along with the medical societies, MGMA calls for the government to award partial credit to practices for achieving some of the goals, rather than basing the awards on an all-or-nothing standard that relatively few practices can meet.

Taking the other side of the argument, officials of AARP, the National Partnership for Women & Families, and the Pacific Business Group on Health (PBGH) argued at a press conference that the proposed rules on "meaningful use" should not be watered down, because they're needed to improve healthcare quality, safety, and efficiency. Christine Bechtel, vice president of the National Partnership for Women & Families, flatly stated that health IT should be used to change how providers deliver care and that it should be considered "a cost of doing business."

David Lansky, president and CEO of PBGH, observed, "Hospitals and doctors have invested heavily in other technologies to increase their bottom line. But they haven't made the same investment in information technology to improve quality and safety, and we expect them to do that."

Apparently, Lansky and Bechtel -- both of whom are on a federal advisory committee that helped formulate the health IT rules -- haven't heard that physicians won't invest in information technology to help employers, consumers, health plans or the government. Unless EHRs help the doctors themselves, they're not interested.

But that isn't a concern to the true believers. One participant in the press conference noted that many physicians have seen 25-30 percent productivity losses in the first year after they implemented EHRs. Bechtel addressed that concern by asserting that the maximum incentive of $44,000 per physician would mostly cover the cost of the software. That may be true, but the software outlay is only about a third of the 5-year cost of owning an EHR. And productivity losses cannot be lightly dismissed.

Lansky and Bechtel did concede that the health IT push can't succeed without a fundamental shift in physician reimbursement that rewards quality over quantity. But that will not happen unless reform legislation is passed. And even then, the health IT regulations will have to be fundamentally rethought to accommodate the realities involved in getting hundreds of thousands of physician to adopt this very complex technology.

Computer image supplied courtesy of Flickr user Jeremy Banks, CC 2.0.