Health News Digest

February 23, 2015

It’s 2015…Let the ARRA/Obamacare EHR Penalties Begin!

By  Michael D. Shaw

A few weeks ago, I had an appointment with my dermatologist–an old school guy, well-loved by his patients. He’s straightforward, no-nonsense, and has long office hours. You know the type: The one you hope will never retire. As I was led to the examining room, I noticed something not too common these days–shelf after shelf of medical records in manila folders. When the doc came into the room, I commented that he did not appear to be an early adaptor of electronic health records (EHRs). He replied that it was definitely worth the Medicare reimbursement penalty (starting in 2015) to not be involved with them.

To anyone in health care, this is no big surprise. Virtually the only people who really like EHRs are the vendors and Federal shills who have been touting them nonstop. Even many of those offices that qualified for “Meaningful Use” of EHRs, and got a cash award for their troubles, are not singing their praises.

Check out these findings from an article entitled “Physician outcry on EHR functionality, cost will shake the health information technology sector,” which appeared in the February 10, 2014 issue of Medical Economics–based on the magazine’s survey of around 1000 physicians:

Despite the government’s bribe of nearly $27 billion to digitize patient records, nearly 70% of physicians say EHR systems have not been worth it…

  • 67% of physicians dislike the functionality of their EHR systems.
  • 45% of respondents say patient care is worse since implementing an EHR.
  • Nearly 23% of internists say patient care is significantly worse.
  • Nearly half of physicians believe the cost of these systems is too high.

As to the cost of EHR, according to the same Medical Economics article: “[N]early 45% of physicians from the national survey report spending more than $100,000 on an EHR system. About 77% of the largest practices spent nearly $200,000 on their systems.” Let’s take a look at those Medicare reimbursement penalties, or as the Feds call them “incentive payment adjustments.”

These are detailed within the 187,000 words (521 pages) of the American Recovery and Reinvestment Act of 2009. Specifically, under TITLE IV—MEDICARE AND MEDICAID HEALTH INFORMATION TECHNOLOGY; MISCELLANEOUS MEDICARE PROVISIONS; Subtitle A—Medicare Incentives; SEC. 4101. INCENTIVES FOR ELIGIBLE PROFESSIONALS; (b) INCENTIVE PAYMENT ADJUSTMENT; (A) ADJUSTMENT.—”(ii) APPLICABLE PERCENT. (Capitalization per source document.)

What it amounts to is 1% in 2015; 2% in 2016; 3% in 2017. And, if fewer than 75% of eligible providers have become meaningful users of EHRs by 2018, the adjustment will increase by one percent each year to a maximum of 5%. Doing the math, a practice would have to be booking a substantial amount of Medicare business for applicable penalties to even approach the cost of an EHR system.

So, how bad are EHR systems? Here are a few choice comments from surgeon Jeffrey A. Singer, that appeared in a Wall Street Journal piece entitled “ObamaCare’s Electronic-Records Debacle.” Singer hardly minces words with his subhead “The rule raises health care costs even as it means doctors see fewer patients while providing worse care.” Then there’s his second paragraph: “I am an unwilling participant in this program. In my experience, EHRs harm patients more than they help.”

To which health care informatics guru Scot Silverstein, MD adds, “[I]t’s not just physicians who are unwilling participants in this medical experiment. We all are–as patients–in this unregulated experiment.”

Singer reviews the history of EHRs, citing their relative success at the VA and Kaiser Permanente. EHR systems were touted by vendors and soulless bureaucrats, who argued that EHRs would facilitate “evidence-based medicine,” thereby improving the quality of care for patients. He continues…

“But for all the talk of evidence-based medicine, the federal government barely bothered to study electronic health records before nationalizing the program. The Department of Health and Human Services initiated a five-year pilot program in 2008 to encourage physicians in 12 cities and states to use electronic health records. One year later, the stimulus required EHRs nationwide. By moving forward without sufficient evidence, lawmakers ignored the possibility that what worked for Kaiser or the VA might not work as well for Dr. Jones.”

Back to Silverstein: “Why are we implementing patient care tools that are not tested for harms, not evaluated for harms, not reported systematically for harms, while the government does not refute the statement that harms are caused by EHRs and admits the true magnitude of harms is unknown?” Malpractice litigation, anyone?

Unless EHR systems drastically improve, I’m thinking that more docs will just take the penalties.