Last January marked the official start of America’s ambitious program to turn its health records electronic, spearheaded by a federal incentive program that will award some U.S. physician up to $44,000 to help pay for their electronic system. The first payments from the government’s $27 billion piggy bank earmarked for electronic health record (EHR) funding began flowing on Jan. 5, including a $42,500 initial payment to two practitioners from the Gastof Family Clinic in Durant, Okla., who had the distinction of being the first individual docs to receive incentive payments.
But what fraction of the EHR cost will $44,000/physician actually cover? Can every U.S. doc, especially those in private practice, afford to pay whatever the cost balance will be to make their system work, and more importantly to keep their system in compliance with the data-reporting demands of the Center for Medicare and Medicaid Services (CMS)?
Some serious questions about the cost and feasibility of compliance came up in a session I covered last week in Las Vegas at the annual meeting of the National Association of Medical Directors of Respiratory Care, when the president of the group, Dr. Steve G. Peters, a Mayo Clinic pulmonologist, talked about what he’s seen as Mayo’s massive resources mobilized in an effort to comply with the demands of the 2009 law that set up the EHR system for Medicare and Medicaid.
The problem is that CMS demands automatic feedback from each physician’s or hospital’s EHR system on several patient-assessment measures and management decisions. “It sounds easy, but it’s not,” Dr. Peters said. “It’s very tricky, and it differs from measure to measure,” leading to a big IT challenge. Even though the Mayo Clinic already had a system-wide EHR in place, tweaking it so that it reports the data that CMS wants remains a work in progress. “We have 85% of it there, but the last 15%is hard.”
What will this mean for the private practitioner with shallow pockets? After Dr. Peters spoke, a comment came from audience member Dr. Theodore S. Ingrassia III, a pulmonologist from Rockford, Ill. He said that he had checked into the costs, and the $44,000 incentive likely will cover just a fraction, perhaps less than 25%, of the eventual cost for IT support to refine a system so that it can do and report everything that the regulations require. And, Dr. Ingrassia added, he can’t foresee himself being in a position to spend that much.
The major hospitals in his area, recognizing his dilemma and those of his fellow private docs, have offered them a deal: the hospital will fund their future IT needs if they forsake their independence and join the hospital’s staff, an option that Dr. Ingrassia didn’t like much either. His current solution? Stall, and hope the 2015 deadline, when CMS penalties are scheduled to start for physicians who have not yet installed an EHR system, will eventually get pushed back or that another, more palatable option emerges.
“Many predicted what you’re experiencing, that this incentive will not buy much,” Dr. Peters said in reply to Dr. Ingrassia. And, Dr. Peters added, “no one will admit it, but there is de facto pressure that there won’t be private practice in the future. Everyone will need to report measures on hundreds of patients,” and to afford to do that they “will need to be part of an organization.”
In short, the U.S. mandate for an EHR that can report back to the government a specified list of patient measures and treatment decisions may become a big, and possibly the final nail in the coffin of private U.S. medical practice.
—Mitchel Zoler (on Twitter @mitchelzoler)