Tag: "electronic medical records"

Rock Star Physician Rebels Against Medicare Bureaucracy

Confident DoctorsRebekah Bernard, MD, who wrote a book titled How to Be a Rock Star Doctor:  The Complete Guide to Taking Back Control of Your Life and Your Profession, has written an open letter to her Medicare patients. Here are the choice bits:

For every office visit that we spend together, I spend at least as much time on what Medicare deems as necessary documentation, especially a new program called meaningful use.

To comply with Medicare requirements, I’ve had to spend thousands of dollars and massive amounts of time instituting electronic health records, adapting my practice to conform to the computer technology that wasn’t created to help me, your physician.

And next year the whole ballgame changes for physicians as the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) goes into full effect, with a complete paradigm shift in Medicare payment from “fee-for-service” (I send a bill for your medical care, Medicare pays me), to “value-based payment” (I submit a bill, and I get paid if Medicare thinks that I’ve done a good enough job).

The kicker is that the pot of money remains constant – so even if every doctor makes an ‘A’ grade, half of them will be paid less money, just by nature of this “budget-neutral” payment system.

Up to this point, I have managed to play by the rules that Medicare has set.

In 2017, this may no longer be the case.

Doctors, Hospitals, Medical Groups Demand EHR Rule Delay

electronic-medical-recordElectronic Health Records (EHRs) continue to take on water:

Calls for the Centers for Medicare & Medicaid Services to refrain from finalizing Meaningful Use Stage 3 are increasing, with the American Medical Association and the Medical Group Management Association adding their voices to the din.

Both organizations cite concerns over the proposed rule as it currently stands, with AMA saying in a letter to CMS Acting Administrator Andy Slavitt and National Coordinator for Health IT Karen DeSalvo that the program “will create significant challenges for physicians, patients, and vendors.”

MGMA adds in its own letter to Slavitt that Stage 3 could result in a failure to meet the goals outlined in the American Recovery and Reinvestment Act of 2009. It should be delayed, MGMA says, until it is known what the impact of Medicare Access and CHIP Reauthorization Act of 2015 will be. (Katie Dvorak, FierceEMR, June 3, 2015).

I discussed the stage 3 rule when it was published. The response of these professional groups is stunning: They were all happy to take the almost $30 billion the government handed out to induce them to install Electronic Health Records.

And they led Congress by the nose just a few weeks go to pass the flawed Medicare Access and CHIP Reauthorization Act. At the time, none of them mentioned it was going to increase the burden of EHR compliance. The first organization to explain this consequence was the NCPA, in report I wrote before the law passed. These groups are asking the government for relief from a flawed so-called Medicare “doc fix” for which they themselves had spent years lobbying.

Electronic Health Records Don’t Help Stroke Victims; And More Bad News

electronic-medical-recordNew research on over half a million stroke victims admitted to hospitals from 2007 to 2010 shows that there was no difference in quality of care for those admitted to hospitals with EHRs and those without:

The new study “is a wake-up call that we should heed,” writes Dr. John Windle, chief of cardiology at University of Nebraska Medical Center, in an accompanying commentary. Windle said electronic health records haven’t been proven to improve quality of health care, the health of large groups of people, or efficiency.

“An [electronic health record’s] first priority must be support of clinical care, not documentation for billing and reimbursement,” Windle said. (Randy Dotinga, HealthDay)

Kick the Medicare Doc Fix Down The Road

Confident Doctors

A similar version of this Health Alert appeared at Forbes.

Congressional leaders from both parties have agreed on a long-term, so-called “doc fix” that claims to solve the problem of how the federal government pays doctors who treat Medicare patients.

Currently, Congress has a certain amount of money every year to pay doctors. This amount of money increases according to a formula called the Sustainable Growth Rate (SGR), which was established in 1997. The SGR is comprised of four factors that (by the standards of federal health policy) are fairly easy to understand. Most importantly, the SGR depends on the change in real Gross Domestic Product (GDP) per capita.

The Medicare Part B program, which pays for physicians, is an explicit “pay as you go” system. Seniors pay one quarter of the costs through premiums, and taxpayers (and their children and grandchildren) pay the rest through the U.S. Treasury. Therefore, it is appropriate taxpayers’ ability to pay (as measured by real GDP per capita) be an input into the amount.

The problem is the amount is not enough. If growth in Medicare’s payments to doctors were limited by the SGR, the payments would drop by about one-fifth, and they would stop seeing Medicare patients. So, at least once a year, Congress increases the payments for a few months. The latest patch (H.R. 4302) was passed in March 2014 and runs through March 31, 2015. It costs $15.8 billion.

This has happened 17 times since 1997. Congress has never allowed Medicare’s physician fees to drop. So, why not pass a long-term fix? This would finally free politicians from having to grub around every year finding money to pay doctors, and they could turn their attention to loftier matters.

Actually, there are plenty of reasons to be skeptical of any “doc fix”, and certainly this one.

3 of 4 Physicians Say Government-Sponsored EHRs Not Worth the Cost

Mitch Morris, MD, of the Deloitte Center for Health Solutions discusses the results of the firm’s latest survey of U.S. physicians:

Three out of four physicians surveyed report that EHRs increase costs and do not save them time. This survey is not alone in its findings: Through another recently released survey, Clem McDonald and colleagues found that physicians say that EHRs “waste an average of 48 minutes per day.”

But those of us working with hospitals and physicians on a regular basis don’t need a survey to tell us things are not quite right. Just look at the rapidly growing profession of scribes — people who follow around doctors taking down their observations for recording in an EHR. Meaningful Use? Really?

Hits and Misses

Government Handouts for Electronic Health Records: Standards Lowered to Ensure Money Keeps Flowing

We recently noted that, halfway through the year, only four hospitals and 50 physicians have achieved the federal government’s goals for “meaningful use” of electronic health records (EHRS). The federal government has a goal of spending $30 billion to induce hospitals and physicians to adopt EHRs, and it still has about $8 billion to spend. In order to ensure the money keeps flowing, standards have been lowered:

The new rule, released May 20 and slated to be published in the Federal Register May 23, would enable providers to use the 2011 edition of certified electronic health record technology for Stage 1 or Stage 2 in 2014. They would have the option to attest to the 2013 definition of Meaningful Use core and menu items and use the 2013 definition of clinical quality measures. (FierceHealth EMR)

So, hospitals and physician practices which received handouts in previous years are pretty much guaranteed to receive a handout this year, just by resubmitting the old paperwork.

Headlines I Wish I Hadn’t Seen

What Are We Getting for the $30 Billion We Are Spending On Electronic Health Records?

electronic-medical-recordIn 2009, the federal government budgeted $30 billion to incentivize doctors and hospitals to install electronic health records and use them “meaningfully”. Here are the results from Boston’s Brigham & Women’s Hospital — one of the leading academic medical centers in the country:

Of 858 physicians, 540 (63%) were “meaningful users”. Meaningful use was associated with marginally better quality for 2 measures, worse quality for 2 measures, and not associated with better or worse quality for 3 measures.

Meaningful use of electronic health records was correlated with better control of cholesterol in patients with diabetes and of blood pressure in hypertensive patients. The meaningful-use group provided worse treatment of asthma and depression than the non-MU group did.

HT: Ken Terry, Medscape.

Hits and Misses