EMR Fear and Loathing at the American Medical Association

If some of the paranoia about health IT that I heard last week at the American Medical Association annual meeting really is representative of practicing physicians -- and not just the protectionist Medical Establishment -- this country is in trouble.

As much as the AMA purports to speak for all doctors, only about one in five U.S. physicians is a dues-paying member these days, and the membership does largely seem like a clubby collection of aging white males who stubbornly cling to the status quo -- particularly when it comes to IT. This is a remarkable situation, given that the status quo in health IT has changed like never before with the the stimulus legislation that allocates a net $19.2 billion for health IT over the next eight years, the bulk of which goes to help doctors and hospitals purchase electronic medical records.

Funny thing is, cantankerous AMA delegates repeatedly claimed they had no input in drafting of the stimulus. Yes, the lobbying group that likes to project the image that it speaks for the nation's physicians felt closed out of the process that is going to provide billions of dollars of aid to medical practices.

Frankly, that's a ludicrous assertion. How come numerous medical specialty societies, particularly the American Academy of Family Physicians, got heard? Why was the relatively small Medical Group Management Association, representing practices of three or more physicians, successful in lobbying on behalf of its membership? The final bill incorporated provisions that had been under consideration for at least three years, and subject to many, many congressional hearings and lobbying opportunities.

Those with a bone to pick included St. Petersburg, Fla., neurosurgeon David McKalip, who believes the incentive program actually penalizes doctors by forcing them to go electronic. McKalip said that an EMR would cost his solo practice $120,000 over five years, much less than the maximum bonus of $44,000 from Medicare or $63,750 from Medicaid. In fact, he's planning on taking the Medicare fee cuts for not using EMRs that take effect in 2015. "It's cheaper for me to take the penalty than to put the system in," he said.

But that was only the beginning of his assault on the stimulus bill, which also boosts federal funding for "comparative effectiveness" research to study and recommend best practices. McKalip called this program "a tool for controlling care and rationing care," believing that Medicare would use the research to tell doctors how to do their jobs and refuse to pay for treatment not meeting official guidelines. That's Big Brother at its worst.

Interestingly, outgoing AMA President Nancy Nielsen said that the organization supports comparative effectiveness research.

The AMA did find many other things wrong with the stimulus, though. The organization's House of Delegates passed a resolution stating that the rush for doctors to install EMRs by the time the incentives start in 2011 will cause a spike in demand for IT products and services, likely driving up prices. That's a fair argument. However, another resolution directs the AMA to tell the federal government that the EMR incentive program "should be made compliant with AMA principles by removing penalties for non-compliance and by providing inflation-adjusted funds to cover all costs of implementation and maintenance of EMR systems."

It's one thing to ask for more money to cover ongoing expenses. It's another thing altogether to conclude that the government is not in compliance with the principles of a private organization. Talk about the tail wagging the dog.