The potential for cuts highlights the pickle facing federal lawmakers as they try to expand healthcare coverage while simultaneously reining in soaring healthcare costs.
"Potential Cuts to Medicaid Outlines by Administration 'Cruel'”, Healthwatch, March 27, 2011
July 6, 2011 - "A pickle", according to my dictionary, is a difficult or awkward situation. As part of the current budget negotiations, the Obama administration has a real pickle on its hands: how to cut tens of billions of dollars from Medicare and Medicaid without alienating its core constituencies and appearing to cruel and heartless.
Federal negotiators say they can do this without imposing new costs , cutting benefits, or threatening access to care.
How would they do this?
• Cutting Medicare payments to hospitals for uncollectable patient debt.
• Reducing payments to hospitals for training of doctors.
• Cutting payments for specialized services like trauma care and organ transplants.
• Eliminating “overpayment”to nursing homes.
• Reducing federal share of Medicaid spending to states.
• Restricting states’ abilities to finance Medicaid.
• Imposing taxes on hospitals and doctors.
Triple Pickle
These proposals pose a triple pickle for federal lawmakers.
One - Can they grasp the “third rail” of American politics, entitlement programs, in this case Medicare and Medicaid which cover 100 million Americans, and which are poised to explode in growth by as much as 50 million for Medicaid in 2014 and to reach 76 million for Medicare by 2019, without being electrocuted politically? We shall see.
Two - Can they threaten the very survival of American hospitals, which derive 55% of their revenues form Medicare and Medicaid? This is why hospitals are spending $1 million a week to defeat the proposals.
Three – Can they maintain access of care in the states , already cutting back on Medicaid to balance broken budgets, to the most vulnerable – children, seniors, the poor, and the disabled, while causing more doctors to drop out of Medicaid and Medicare because of lowered reimbursements. I doubt it. Doctors surveys indicate as many as 40% to 60% of doctors may opt out of Medicare and Medicaid.
The AMA and AARP have joined hospitals and nursing homes in the fight against proposals that would cut federal spending as a percentage of GDP. That percentage is now 23%, and it is growing relentlessly and uncontrollably.
In good times, it is easy for politicians to giveth, but it is hard to taketh away.
Politicians are confronted with a formidable and bitter-tasting Triple Pickle.
One, how to avoid third rail electrocution when squeezing the Federal Nickel.
Two, how to keep from devastating the states by decreasing the downward Medicaid Trickle.
Three, how to prevent massive doctor shortages while cutting their pay with a federal a Hammer and a Sickle.
No longer can fickle politicians down the road the can kickle.
Wednesday, July 6, 2011
Tuesday, July 5, 2011
Health Reform: Acronym Proliferation As A Sign of the Evolving Role of Community Health Centers To Serve the Growing Medicaid Population
We propose a novel care delivery system: Community Health Centers and Academic Medical Partners, or CHAMPS. CHAMPS would combine the subspecialist’s expertise, medical technology, and inpatient care of local academic medical centers (AMCs) with the primary care expertise of CHCs, utilizing an emerging subgroup CHCs known as teaching medical centers (THCs) to create a distinctive form of accountable care organization (ACO). We believe combining the best elements of AMCs and CHCs, these CHAMP ACOs could deliver high-quality, cost-effective care to low-income Americans while training the next generation of health-care professionals.
Richard E. Riesenbach MD, and Arthur L. Kellermann, MD, “A Model Health Care Delivery System for Medicaid,” New England Journal of Medicine, June 30, 2011
July 5, 2011 - One sure sign of growing government role in caring for expanding Medicaid populations is the proliferation of acronyms to explain what is going on.
This is apparent in the introductory paragraph to this blog. It contains 6 acronyms – CHAMPS, AMCs, CHCs, THCs, ACOs, and CHAMP ACOS. The paragraph does not mention CMS, the Center for Medicare and Medicaid Services, an acronym representing the most powerful and biggest delivery model of them all with $1 billion in federal revenues.
No Quarrel
I have no quarrel with use of acronyms or the organizations they represent. Acronyms serve a useful purpose – brevity- but they also add confusing bureuacatic alphabet soup to current efforts to reform health.
I applaud the noble ideas of CHAMP ACOs, which would theoretically.
• Use senior residents as primary care providers funded by Medicare.
• Eliminate billing costs and administrative costs through global capitation.
• Decrease hospital admissions and ER visits that could be treated on an ambulatory basis.
• Decrease hospital costs and admissions.
• Decrease laboratory and imaging costs because teaching programs would mandate appropriate resource use.
• Decrease fragmentation of care with effective access to and use of consultations.
• Protect against medical liability for CHCs under the Federal Tort Claims Act.
• Effectively manage prevention and management of chronic disease.
• Proved integrated dental and mental health services.
• Advance use of electronic medical records and medical home developments through use current federal programs.
Dubious
Still, I am dubious about these propositions for these reasons.
1. They are theoretical and untested.
2. They assume academic centers have management skills they may not possess.
3. They assume CHAMPs ACOs would be immune to antitrust laws and malpractice.
4. They rely on federal funding and daunting set of regulatory challenges.
As the authors themselves say, “The biggest obstacle to CHAMPS is not financial, but regulatory. A recently proposed rule of the Centers for Medicare and Medicaid Services (CMS) will bar Medicare patients who get their primary care from a CHC from joining an ACO.
This can be overcome, say the authors, by assigning each THC patient to a primary care resident and a supervising physician. They add that working in a well –managed THC might encourage more primary care residents to join a CHC when they complete training, especially given the incentive of debt repayment through the National Health Services Corps (NHSC).
This may be. Certainly, it will take thousands primary care physicians to care for the 20 million Medicaid patients now cared for by Community Health Centers, soon to be joined in 2014 by 16 million more mandated by the Accountable Care Act, and perhaps even 20 to 30 million more if 30% of employers drop coverage for 80 to 100 million Americans, as a recent McKinsey survey of employers suggests.
I wonder if academic medical centers, their faculty and residents, outside practitioners, and patients themselves will understand how to navigate the acronymic jungle.
Conclusion
Acronyms aside, it is apparent to me Community Health Centers, which now serve 20 million Medicaid recipients, will continue, indeed, will have to grow when as many as 50 million more Americans come at board the Medicaid ship. There are now 3000 Community Health Centers, and there will soon be more. Some will be run by existing staffs of primary care physicians, others by nurse practitioners, still others perhaps by academic health centers. Whoever runs them, these Community Health Centers will be the bedrock model for delivering care to an exploding Medicaid population.
Richard E. Riesenbach MD, and Arthur L. Kellermann, MD, “A Model Health Care Delivery System for Medicaid,” New England Journal of Medicine, June 30, 2011
July 5, 2011 - One sure sign of growing government role in caring for expanding Medicaid populations is the proliferation of acronyms to explain what is going on.
This is apparent in the introductory paragraph to this blog. It contains 6 acronyms – CHAMPS, AMCs, CHCs, THCs, ACOs, and CHAMP ACOS. The paragraph does not mention CMS, the Center for Medicare and Medicaid Services, an acronym representing the most powerful and biggest delivery model of them all with $1 billion in federal revenues.
No Quarrel
I have no quarrel with use of acronyms or the organizations they represent. Acronyms serve a useful purpose – brevity- but they also add confusing bureuacatic alphabet soup to current efforts to reform health.
I applaud the noble ideas of CHAMP ACOs, which would theoretically.
• Use senior residents as primary care providers funded by Medicare.
• Eliminate billing costs and administrative costs through global capitation.
• Decrease hospital admissions and ER visits that could be treated on an ambulatory basis.
• Decrease hospital costs and admissions.
• Decrease laboratory and imaging costs because teaching programs would mandate appropriate resource use.
• Decrease fragmentation of care with effective access to and use of consultations.
• Protect against medical liability for CHCs under the Federal Tort Claims Act.
• Effectively manage prevention and management of chronic disease.
• Proved integrated dental and mental health services.
• Advance use of electronic medical records and medical home developments through use current federal programs.
Dubious
Still, I am dubious about these propositions for these reasons.
1. They are theoretical and untested.
2. They assume academic centers have management skills they may not possess.
3. They assume CHAMPs ACOs would be immune to antitrust laws and malpractice.
4. They rely on federal funding and daunting set of regulatory challenges.
As the authors themselves say, “The biggest obstacle to CHAMPS is not financial, but regulatory. A recently proposed rule of the Centers for Medicare and Medicaid Services (CMS) will bar Medicare patients who get their primary care from a CHC from joining an ACO.
This can be overcome, say the authors, by assigning each THC patient to a primary care resident and a supervising physician. They add that working in a well –managed THC might encourage more primary care residents to join a CHC when they complete training, especially given the incentive of debt repayment through the National Health Services Corps (NHSC).
This may be. Certainly, it will take thousands primary care physicians to care for the 20 million Medicaid patients now cared for by Community Health Centers, soon to be joined in 2014 by 16 million more mandated by the Accountable Care Act, and perhaps even 20 to 30 million more if 30% of employers drop coverage for 80 to 100 million Americans, as a recent McKinsey survey of employers suggests.
I wonder if academic medical centers, their faculty and residents, outside practitioners, and patients themselves will understand how to navigate the acronymic jungle.
Conclusion
Acronyms aside, it is apparent to me Community Health Centers, which now serve 20 million Medicaid recipients, will continue, indeed, will have to grow when as many as 50 million more Americans come at board the Medicaid ship. There are now 3000 Community Health Centers, and there will soon be more. Some will be run by existing staffs of primary care physicians, others by nurse practitioners, still others perhaps by academic health centers. Whoever runs them, these Community Health Centers will be the bedrock model for delivering care to an exploding Medicaid population.
Monday, July 4, 2011
Health Reform: On Biggering Government and Belittling Individuals
July 4, 2011 - This nation was founded on these notions:
• Each person contributes.
• It is not how big you are, but what you do that counts.
• The constitution protects individuals.
• Collective actions of individual voters over-rule government.
• Voices of individuals must be heard.
Op-Ed
In a June 26, 2011, Houston Chronicle Op-Ed, “Government Favors Bigger Health Providers, “ Louis Goodman and Timothy Norbeck, president and executive director of the Physicians Foundation, remind us of the dangers of government bigness in health care .
Here is their article.
Who would deny that health care is big business? It is also the most personal of all human endeavors. Why then does the federal government appear to be in such a rush to depersonalize our medical care? Bending the cost curve seems to be the driving force behind the recent health care reform, especially in light of the fact that national health expenditures have doubled over the past decade from $1.3 trillion in 2000 to $2.6 trillion in 2010. And the Affordable Care Act rewards hospital systems at the expense of small and solo, personally oriented medical practices, under the mistaken theory that bigger systems are — or can be - more cost-effective.
Where were the voices of patients and practicing physicians, two of the most important constituencies in these discussions? The answer is, their voices didn't matter to the reformers. There was a time when physicians and their patients worked together to determine what was best for the patient. Such participation has been ceded to the federal government.
The question of size may well be the most important aspect of the congressional overhaul. More than 80 percent of personal medical care services are provided in the doctor's office, and less than 20 percent of services are provided in the hospital.
Why should health care delivery remain in the doctor's office? Because it is the most cost-effective setting to receive health services. Medicare says the average visit to the doctor's office costs $61, compared to an average visit to the hospital of $10,908.
Why then is Congress pushing as many services as possible to the hospital through consolidation, merger, acquisition and shared savings programs? If the hospital is the most expensive place to provide care and the physician's office is the most cost-effective place to receive care, why has Congress moved care away from the doctor's office and into a hospital waiting room?
The answer appears quite evident. Congress and the executive branch of government believe that a single-payer system is where health system reform will rapidly evolve from our current system.
Here is the evidence.
First, the government's share of our national health care bill, which was 44 percent in 2000, is projected to be 50 percent in 2010. Or more aptly stated, the government's share of national health care expenditures has doubled over the past decade from $596 billion in 2000 to $1.3 trillion in 2010.
Second, hospital systems are getting bigger, and in many markets, they exercise monopoly power. For example, the Texas Attorney General's office filed suit against a large Houston-based health care system alleging violation of state antitrust statutes by unreasonably restraining competition among acute care in-patient hospitals.
Third, physician practices are evolving from predominantly solo practice to four or five doctor groups in order to remain economically viable. Large hospital systems are rapidly gobbling up small hospitals, and large health insurers are purchasing small insurers, further eroding what little competitiveness remains in the market.
After a short period of predatory practices, monopolistic dominance will result in higher prices, less service and arbitrary control over patient waiting times. And sooner rather than later, only a few big hospital systems and health insurance companies will remain.
Voila! Then the federal government will proclaim that there is no competition in the health care marketplace and therefore the government must intervene and create a national health service. Economist Milton Friedman's comment about the inefficacy of government resonates today. If you put the federal government in charge of the Sahara Desert, he said, in five years there would be a shortage of sand. And so it will be with health care.
In order to move forward, physicians and patients must become part of the dialogue. Decisions cannot simply be made by large health systems and the federal government. A more constructive discussion is needed or patients, and we are all patients eventually, will incur long waiting lines, rationing of care and higher taxes.
Conclusion
I conclude with this verse, borrowed and modified from Doctor Suess’s tale, The Lorax, with apologies to the good doctor.
Government is government!
And government must grow!
It has to grow bigger,
so bigger it gets.
It biggers the size of medical groups.
It biggers the size of hospitals.
It biggers the size of health plans.
It biggers the size of the load states must carry.
It biggers the size of Medicare and Medicaid.
It biggers the size of the tax bill.
And it figures,
on biggering,
and biggering.
To grow even bigger,
It belittles voices of individual patients.
It belittles voices of independent solo physicians.
It belittles voices of small entrepreneurs.
It belittles voices of individual innovators.
It belittles the voice of the market.
And it figures,
on belittling,
and belittling,
until it grows as big,
as it can get.
• Each person contributes.
• It is not how big you are, but what you do that counts.
• The constitution protects individuals.
• Collective actions of individual voters over-rule government.
• Voices of individuals must be heard.
Op-Ed
In a June 26, 2011, Houston Chronicle Op-Ed, “Government Favors Bigger Health Providers, “ Louis Goodman and Timothy Norbeck, president and executive director of the Physicians Foundation, remind us of the dangers of government bigness in health care .
Here is their article.
Who would deny that health care is big business? It is also the most personal of all human endeavors. Why then does the federal government appear to be in such a rush to depersonalize our medical care? Bending the cost curve seems to be the driving force behind the recent health care reform, especially in light of the fact that national health expenditures have doubled over the past decade from $1.3 trillion in 2000 to $2.6 trillion in 2010. And the Affordable Care Act rewards hospital systems at the expense of small and solo, personally oriented medical practices, under the mistaken theory that bigger systems are — or can be - more cost-effective.
Where were the voices of patients and practicing physicians, two of the most important constituencies in these discussions? The answer is, their voices didn't matter to the reformers. There was a time when physicians and their patients worked together to determine what was best for the patient. Such participation has been ceded to the federal government.
The question of size may well be the most important aspect of the congressional overhaul. More than 80 percent of personal medical care services are provided in the doctor's office, and less than 20 percent of services are provided in the hospital.
Why should health care delivery remain in the doctor's office? Because it is the most cost-effective setting to receive health services. Medicare says the average visit to the doctor's office costs $61, compared to an average visit to the hospital of $10,908.
Why then is Congress pushing as many services as possible to the hospital through consolidation, merger, acquisition and shared savings programs? If the hospital is the most expensive place to provide care and the physician's office is the most cost-effective place to receive care, why has Congress moved care away from the doctor's office and into a hospital waiting room?
The answer appears quite evident. Congress and the executive branch of government believe that a single-payer system is where health system reform will rapidly evolve from our current system.
Here is the evidence.
First, the government's share of our national health care bill, which was 44 percent in 2000, is projected to be 50 percent in 2010. Or more aptly stated, the government's share of national health care expenditures has doubled over the past decade from $596 billion in 2000 to $1.3 trillion in 2010.
Second, hospital systems are getting bigger, and in many markets, they exercise monopoly power. For example, the Texas Attorney General's office filed suit against a large Houston-based health care system alleging violation of state antitrust statutes by unreasonably restraining competition among acute care in-patient hospitals.
Third, physician practices are evolving from predominantly solo practice to four or five doctor groups in order to remain economically viable. Large hospital systems are rapidly gobbling up small hospitals, and large health insurers are purchasing small insurers, further eroding what little competitiveness remains in the market.
After a short period of predatory practices, monopolistic dominance will result in higher prices, less service and arbitrary control over patient waiting times. And sooner rather than later, only a few big hospital systems and health insurance companies will remain.
Voila! Then the federal government will proclaim that there is no competition in the health care marketplace and therefore the government must intervene and create a national health service. Economist Milton Friedman's comment about the inefficacy of government resonates today. If you put the federal government in charge of the Sahara Desert, he said, in five years there would be a shortage of sand. And so it will be with health care.
In order to move forward, physicians and patients must become part of the dialogue. Decisions cannot simply be made by large health systems and the federal government. A more constructive discussion is needed or patients, and we are all patients eventually, will incur long waiting lines, rationing of care and higher taxes.
Conclusion
I conclude with this verse, borrowed and modified from Doctor Suess’s tale, The Lorax, with apologies to the good doctor.
Government is government!
And government must grow!
It has to grow bigger,
so bigger it gets.
It biggers the size of medical groups.
It biggers the size of hospitals.
It biggers the size of health plans.
It biggers the size of the load states must carry.
It biggers the size of Medicare and Medicaid.
It biggers the size of the tax bill.
And it figures,
on biggering,
and biggering.
To grow even bigger,
It belittles voices of individual patients.
It belittles voices of independent solo physicians.
It belittles voices of small entrepreneurs.
It belittles voices of individual innovators.
It belittles the voice of the market.
And it figures,
on belittling,
and belittling,
until it grows as big,
as it can get.
Sunday, July 3, 2011
Health of the Nation - July 3, 2011
The physical health of the nation is good.
Women on average live to 81, men to 79.
Take away deaths from violence and accidents,
And we are among the world’s longest living.
Our psychological health is not so good.
Only 74% of Americans approve of Congress.
Another 66% feel we are headed in the wrong direction.
Only 37% approve of Obama's economic performance.
Most Americans are depressed about their future.
The economic health is stagnant or bad
if you ignore last week’s Dow Jones 600 point surge,
and news last year CEO pay rose 26% to $10.8 million.
Democrats spout it will only get better and better,
if only we share sacrifice and tax those filthy rich.
Republicans shout it will only go from bad to worse,
if we don’t stop spending ourselves into a ditch.
The health system’s health is on hold,
waiting for Obamacare to roll or fold.
Its fate will depend on the Supreme Court,
whether the health law will thrive or abort.
Tomorrow is the Fourth of July,
Happy 235th Birthday, America!
Here’s to your Health!
Women on average live to 81, men to 79.
Take away deaths from violence and accidents,
And we are among the world’s longest living.
Our psychological health is not so good.
Only 74% of Americans approve of Congress.
Another 66% feel we are headed in the wrong direction.
Only 37% approve of Obama's economic performance.
Most Americans are depressed about their future.
The economic health is stagnant or bad
if you ignore last week’s Dow Jones 600 point surge,
and news last year CEO pay rose 26% to $10.8 million.
Democrats spout it will only get better and better,
if only we share sacrifice and tax those filthy rich.
Republicans shout it will only go from bad to worse,
if we don’t stop spending ourselves into a ditch.
The health system’s health is on hold,
waiting for Obamacare to roll or fold.
Its fate will depend on the Supreme Court,
whether the health law will thrive or abort.
Tomorrow is the Fourth of July,
Happy 235th Birthday, America!
Here’s to your Health!
Saturday, July 2, 2011
Eulogy for Personal Health Records
The first-self constituted, self-declared, self-created people in the history of the world.
John Adams (1735-1826),President of the United States, on Independence Day
Despite all the encroachments on our freedoms, we remain more free than anyone, anywhere, and in an ineffable way that no one else but an American or would-be American can completely understand.
Ralph Kinney Bennett, “This Astonishing Enterprise,” The American, The Journal of the American Enterprise Institute, July 1. 2011
July 2, 2011 - On June 29, 2011 in The Health Care Blog, Missy Krasner, a founding member of Google Health and former senior adviser to David Brailer, MD, first National Coordinator of Health IT, the $27 billion program to stimulate a national interoperative program for electronic health records, delivered an informal eulogy on the death of Google Health, a corporate program designed to deliver Personal Health Records for every America, a project Google has decided to shut down.
What is the Google abandonment of a cherished national goal of universal IT all about?
In my opinion, it’s about the desire of American consumers and providers for freedom from data entering and usage to tether – i.e. control - patient and physician behavior. Those on the government side of the aisle will no doubt argue that data is the only objective and rational means to control costs and improve care. Other national health systems have adopted IT across the board. We can't we be more like them, more responsive to government.
I understand their argument. But I believe it is unworkable and impractical in a diverse, freedom-loving country like America, which cherishes self-choice and self-freedoms to make one’s individual decisions rather than deploying data to dictate clinical decisions.
In her article, “The PHR School of Hard Knocks.” Missy Krasner, an accomplished IT expert, gives the following reasons why Personal Health Records in America have bit the dust.
1. Health care is paternalistic – consumers are blind to costs and data. Thi, of course, is true. Most patients and most doctors consider what takes place in the exam room, hospital room, and physician’s office to be a personal matter, not to be tampered with or tethered to data.
2. PHRs are boring, too generic, and not social enough – True again. Who cares about statistical data on thousands of other people, which may or may not apply to the individual person, and which may dash hopes of cure or improvement of health.
3. People want convenience not medial archiving. From IT, consumers want:
The ability to securely email their doctor for a quick, informed medical opinion.
To ask online for a refill.
To make an on-appointment.
To find personalized information.
4. Authenticating data is a bitch – Entering, securing, and implementing data takes time and energy, is not reimbursable, and disrupts normal practice pattern.
5. To tether or not to tether - This is a huge problem. Tether, according to my dictionary, is a rope or chain attached to something on the other end, thus restraining the animal’s movement. Humans, especially Americans, do not like to tethered to government by a chain of data, or to be considered something impersonally, like a government's pet.
Whether the death of Google's Personal Health Records is a precedent for the demise of electronic medical or health records in general in unlikely, but it does not bode well for the universal installation of electronic records as the principal means of monitoring or controlling health care.
John Adams (1735-1826),President of the United States, on Independence Day
Despite all the encroachments on our freedoms, we remain more free than anyone, anywhere, and in an ineffable way that no one else but an American or would-be American can completely understand.
Ralph Kinney Bennett, “This Astonishing Enterprise,” The American, The Journal of the American Enterprise Institute, July 1. 2011
July 2, 2011 - On June 29, 2011 in The Health Care Blog, Missy Krasner, a founding member of Google Health and former senior adviser to David Brailer, MD, first National Coordinator of Health IT, the $27 billion program to stimulate a national interoperative program for electronic health records, delivered an informal eulogy on the death of Google Health, a corporate program designed to deliver Personal Health Records for every America, a project Google has decided to shut down.
What is the Google abandonment of a cherished national goal of universal IT all about?
In my opinion, it’s about the desire of American consumers and providers for freedom from data entering and usage to tether – i.e. control - patient and physician behavior. Those on the government side of the aisle will no doubt argue that data is the only objective and rational means to control costs and improve care. Other national health systems have adopted IT across the board. We can't we be more like them, more responsive to government.
I understand their argument. But I believe it is unworkable and impractical in a diverse, freedom-loving country like America, which cherishes self-choice and self-freedoms to make one’s individual decisions rather than deploying data to dictate clinical decisions.
In her article, “The PHR School of Hard Knocks.” Missy Krasner, an accomplished IT expert, gives the following reasons why Personal Health Records in America have bit the dust.
1. Health care is paternalistic – consumers are blind to costs and data. Thi, of course, is true. Most patients and most doctors consider what takes place in the exam room, hospital room, and physician’s office to be a personal matter, not to be tampered with or tethered to data.
2. PHRs are boring, too generic, and not social enough – True again. Who cares about statistical data on thousands of other people, which may or may not apply to the individual person, and which may dash hopes of cure or improvement of health.
3. People want convenience not medial archiving. From IT, consumers want:
The ability to securely email their doctor for a quick, informed medical opinion.
To ask online for a refill.
To make an on-appointment.
To find personalized information.
4. Authenticating data is a bitch – Entering, securing, and implementing data takes time and energy, is not reimbursable, and disrupts normal practice pattern.
5. To tether or not to tether - This is a huge problem. Tether, according to my dictionary, is a rope or chain attached to something on the other end, thus restraining the animal’s movement. Humans, especially Americans, do not like to tethered to government by a chain of data, or to be considered something impersonally, like a government's pet.
Whether the death of Google's Personal Health Records is a precedent for the demise of electronic medical or health records in general in unlikely, but it does not bode well for the universal installation of electronic records as the principal means of monitoring or controlling health care.
Friday, July 1, 2011
Electronic Medical Records May Not Be What They Are Cracked Up To Be
July 1, 2011- Sometimes it takes a while for the truth to sink in. In this case, the truth is: electronic medical records may not be what they are cracked up to be. Many doctors in small practices feel:
• EHRs often cost more than they are worth.
• They slow up practice.
• They may not prevent errors.
• They dehumanize practice by getting between the doctor and the patient.
It is, of course, impolitic to question the value of EHRs. If you do so, you are considered a Luddite, a reactionary stuck in the muck. But some of us continue our wayward ways anyway, as I do repeatedly in my book The Health Reform Maze (Greenbranch Publishing), due out later this summer.
Small practices have joined the chorus. As a June 30 Kaiser Health News piece, points out: only 7% of one or two person practices have installed EHRs. The voices of dissenting small practices is beginning to be heard.
Small Doc Groups Question Advantages of Health IT
By Bara Vaida
The government is offering as much as $27 billion in incentives to doctors and hospitals to adopt electronic health records, but the question is whether those incentives will be enough.
A new study published by the Center for Studying Health System Change and the National Institute for Health Care Reform illustrates the difficulty of getting everyone in the health care system to adopt electronic records.
The two organizations found that some physician practices with 25 or fewer doctors who were early adapters of electronic health records are unsure that their investment of time and money has been worth it.
“Despite the widely held belief that HIT adoption ultimately will save costs and improve quality, several respondents suggested the business case – adequate financial incentives and return on investment – remains somewhat unclear, especially in the short term,” said the report.
The study focused on five independent practice associations (IPAs) that had purchased health information technology systems to enable a range of functions from sending prescriptions to pharmacies electronically to accessing local laboratory and hospital clinical information. IPAs are legal entities that represent groups of independent physicians who have agreed to share in support costs. To gather information for the survey, the institute telephoned 27 people involved in the IPAs between March and May 2010.
Among the problems the early adapters cited were technical difficulties and lack of training offered by health IT providers, lost productivity while staff learned to use the electronic systems, and the inability to get systems to talk to other electronic health systems.
Nationally, only 7 percent of doctors with one or two physicians have adopted electronic health systems. Since more than half of doctors practice in groups of five or fewer doctors, physicians have a long way to go in joining the age of health IT.
Despite the challenges listed in the study, the Center for Studying Health System Change and the National Institute for Health Care Reform said the challenges faced by these early adapters could serve as lessons learned to help small physician groups, who likely will have to buy health IT systems if they want to treat Medicare patients in the future. As part of the health law, doctors treating Medicare patients will face a penalty if they aren’t using electronic records by 2015.
bvaida@kff.org
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