EHR Story: Mastodons in Kitchen and Elephants in Refrigerator Come in from out of the Cold

The elephant in the room of what we’re trying to do is in the small physician practice. That’s the hardest part, and it will bring this effort to its knees if we fail.

David Brailer, MD, National Coordinator for Health Information Technology for Bush Administration, in 2005 New York Times Interview on prospects for universal national interoperative electronic record system

February 19, 2012 - Doctor Brailer’s 2005 comment came to mind as I was listening to Alan Simpson on a February 16 C-Span call-in show. The colorful, plain spoken 80 year old senator from Wyoming from 1979 to 1997 and co-chair of the Bowles-Simpson National Commission on Fiscal Responsibility and Reform, was talking about the U.S. budget deficit and failures to address it.

To one call-in viewer, Simpson referred to critics of the Bowles-Simpson plan as “mastodons in the kitchen” and “elephants in the refrigerator.” For the U.S. economy, Simpson was predicting, the Ice Age Cometh if we do not get our debt under control.

In health reform, the mastodons are the hospitals and the elephants are the doctors. Some critics consider hospitals and doctors as Ice-Age relics of modern information technology. When you strip away the rhetoric, the high-minded talk about ACOs, EHRs, Medical Homes, and demonstration projects, health reform success comes down to how fast hospitals and doctors adopt information technologies.

On April 27, 2004, President George Bush called for America to have a national interoprrative electronic health information system by 2014. Well, after nearly eight years of being out in the HIT cold, hospitals and doctors are finally warming up to HIT adoption.

Kathleen Sebelius, Secretary of Health and Human Services, has announced, as of February 2012, hospitals and doctors have received $3.12 billion in incentive payments for adopting “meaningful use” of EHRs. This is a fraction of the $27 billion the 2009 $787 billion stimulus bill set aside for HIT (Health Information Technologies). Never mind, it’s a start.

Sebelius says more than 2000 hospitals of the nation’s 5500 hospitals and 41,000 of its estimated 550,000 practicing doctors (estimates of the actual number of practicing doctors varies from 500,000 to 950,000) have adopted EHRs. For hospitals, HIT use more than doubled from 16% to 35% from 2009 to 2011. In January 2012,CMS paid $519 million to hospitals and doctors for HIT – a term used synonymously with EHR adoption. That leaves 3500 hospitals and roughly 509,000 doctors to go before EHR adoption becomes universal.

Hospitals and doctors are rushing to meet the February 29, 2012 deadline for the first year of incentive payments. Those who qualify will be eligible for the 2nd year of incentive payments. Sebelius estimates 65% of hospitals will take advantage of incentives by 2015. She has not projected 2015 figures for doctors.

But it is safe to say more mastadons and elephants will gather at the EHR payment trough by 2015. The government’s financial temptations -totaling $44,000 for each physician for Medicare incentives, $63.750 for each physicians for Medicaid incentives, and $2 million for each hospital in incentives incentives – will simply be too great to resist).

Of the HIT future, Secretary Sibelius says,

“Health IT is the foundation for a truly 21st century system where we pay for the right care, not just more care. Health care professionals and hospitals are taking advantage of this unprecedented opportunity to begin using smarter, new technology that improves care and creates the jobs we need for an economy built to last.”

How long our economy and our international creditors will tolerate expenditures of this magnitude will depend on the size of our national debt. Until then, on the other side of the ledger, the maxim “Pay them, and they will come” will hold true.

Tweet: CMS has paid hospitals and doctors $3.12 billion to adopt electronic health records, and the adoption pace is accelerating.