According to the latest figures from the Centers for Medicare and Medicaid Services, the Medicare and Medicaid Electronic Health Records Incentive Program has now paid out over US $7 billion since January 2011 to over 100 000 healthcare providers that meet federal EHR use standards, a story at Government Executive magazine reports. The incentive program was set up under the HITECH Act of 2009 to encourage the adoption of EHR systems and use them “in ‘meaningful’ ways that lead to higher quality care, improved patient safety, and shared decision making by patients and physicians.” Eligible healthcare professionals can receive up to $44 000 through the Medicare EHR Incentive Program and up to $63 750 through the Medicaid EHR Incentive Program. In addition, there are penalties planned to be introduced in 2015 and increased over time for healthcare providers who aren't using EHR systems by then.
As I noted last month, within the medical community, the debate over the value of EHR systems has become increasingly heated as more healthcare providers adopt them. A survey report (pdf) released last week from Accenture will likely add more fuel to the fire.
According to Accenture, private practice doctors are saying that the cost of EHR systems is increasingly becoming a deciding factor in whether they continue to operate as an independent practice or close it down, typically to be hired as a hospital employee. Over the past decade, “the number of independent U.S. physicians has dropped dramatically, from 57 percent in 2000 to 39 percent in 2012,” Accenture states, and this number is expected to drop to only 36 percent by the end of 2013.
Accenture states that its survey indicates that “business operations are one of the main reasons why 61 percent of physicians have decided to seek employment, with cost and expense of running a business indicated as the chief concern for 87 percent of those independent doctors surveyed.” Furthermore, the cost and hassle involved in installing and operating EHR systems is given by 53 percent of doctors surveyed as a main reason for giving up their private practice.
Also appearing this week in the Washington Post was a timely article that discusses the reasons behind the decision by several highly experienced doctors not to install an EHR system in their private practices, despite the Federal government’s incentive program. While the EHR system cost was a factor in their decisions—one doctor said he was quoted about $30 000 upfront for a system—which likely would be covered by the incentive (there was also $2000 a month in subscription fees and another $300 a month for cyber insurance to cover against data breaches, not to mention the lost productivity for several months during the transition from paper to digital records)—doubt about whether an EHR system would really improve their effectiveness as doctors was also voiced as a major barrier to installing one. As one internist noted, “We have 10 000 diagnoses and thousands of medicines. It’s not like automating that would make it easier.” (That point may spawn another debate in the near future; EHRs might be a necessary step in applying IBM's Watson and other technologies to improve the accuracy of doctors' diagnoses, thereby raising the issue about whether EHR systems should become mandatory as a standard of medical practice.)
The Accenture report indicated that doctors who wish to stay in private practice should look to increasing their revenue and reducing their costs by turning to subscription-based models like that offered by Multnomah Family Care Center, a Patient/ Physician Cooperative in Portland, Oregon, where “patients pay a one-time enrollment fee to join, and then pay monthly membership and primary care provider fees, which combined average less than $60 a month.” Patients there use their health insurance to pay for “acute conditions or emergencies,” but otherwise, patients pay the doctor directly for their medical care, thereby bypassing many of the limits on payments imposed by insurance companies or the Federal government.
What this all implies, given that, as a consequence of the Affordable Care Act, millions of previously uninsured American families will soon be looking for doctors, is open to speculation. But I would hazard a guess that if the cost of EHR systems continues to encourage doctors to leave private practice or turn to a subscription-based model, the planned financial penalties for not "meaningfully" using certified EHR system by 2015 will be postponed or incentive rates increased.