Healthcare // Electronic Health Records
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10/18/2011
11:23 AM
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Are EHR Incentives A Waste Of Money?

Critics charge that Meaningful Use incentives only reward longtime users of health IT rather than encourage new electronic health record adoption.

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Of the healthcare providers that received the first batch of federal incentive payments for Meaningful Use of electronic health records (EHRs), around half were using EHRs for several years or longer before the government program began, according to a survey by iWatch News, a publication of the Center for Public Integrity. IWatch News interviewed 62 doctors and hospitals--about a sixth of the total that received incentive payments last spring--to obtain the data for its analysis.

"The analysis could raise questions about whether the government will be able to meet its goal of widespread adoption of health information technology," the iWatch News article said. "While these early numbers are hardly conclusive, they suggest that a large swath of payments intended to be an incentive for new adoption of electronic health records are merely rewarding health providers for minor adjustments to systems they have had in place for years."

Peter Basch, MD, medical director for ambulatory EHR and health IT policy at Medstar Health in Washington, D.C., strongly disagreed with iWatch's conclusions. Basch, a senior fellow on health IT policy at the Center for American Progress, told InformationWeek Healthcare he wasn't surprised that the first bunch of physicians to attest to Meaningful Use included a lot of early adopters. However, he said, "It doesn't indicate there's anything wrong with the program."

The EHR incentive program, he said, is not designed to reward providers who purchase the technology. "It's designed to help move a majority of doctors and hospitals to a 21st century electronic infrastructure in order to provide better and more affordable care. Just putting technology in place doesn't do that. The technology must have certain capabilities, and it must be used in certain ways."

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Only 3,700 physicians had attested to Meaningful Use by September 30, six months after the program began to accept attestations. In Basch's view, that shows it's not easy to demonstrate Meaningful Use, even for early adopters. Some of those who have used EHRs for years had to switch to new systems or pay for expensive updates, he noted.

Even Medstar, which has had EHRs for 15 years, had to make many workflow and documentation changes so that complying with the Meaningful Use requirements would actually improve care, Basch observed. Consequently, the organization waited until the final 90-day period of 2011 to start measuring the performance of the first group of Medstar physicians.

Basch contended it would be unfair to penalize providers who invested in EHRs before January 1, 2010 and only reward those who delayed acquiring the technology. Many of those who invested in EHRs without hope of government incentives, he noted, helped "inform the direction" of health IT toward quality improvement.

It's also nonsensical, he said, to suppose that if early adopters receive incentives, the government is going to run out of money and not be able to make payments to physicians who buy EHRs now. The Centers for Medicare and Medicaid Services estimated that the government would pay out between $14 billion and $27 billion in incentives over five years, and little of that has been spent to date, he pointed out.

The iWatch article quoted several individuals who took pro and con positions on the issue of paying early adopters. Among them was a spokesman for Sen. Tom Coburn (R-Okla.), an obstetrician who has publicly called for elimination of the health IT incentive program. "If providers have been paid for systems they already had in place, that seems to be an inexcusable waste of taxpayer dollars," Coburn's representative reportedly said. "It makes no sense for HHS to pay physicians for systems they already have."

That comment, Basch said, "reflects a misunderstanding of the Meaningful Use program." Rather than being a government subsidy, he said, the EHR incentive initiative represents an investment designed "to induce change in the system so that the government will spend less money on healthcare in the long run."

Nevertheless, in the current political climate, "lots of things are on the potential chopping block that one would have thought were off limits, including Medicare," he pointed out. If it came to a choice between cutting Medicare and eliminating health IT incentives, he said, Coburn's suggestion might be taken seriously. However, he added, "they can't just cut it. It would take a legislative effort to do that."

"That would be a mistake," he argued, because the system can't deliver "better quality and safety and more affordable choices" without health IT.

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MediWorx
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MediWorx,
User Rank: Apprentice
10/24/2011 | 1:02:49 PM
re: Are EHR Incentives A Waste Of Money?
Many practices have had to make substantial upgrades in order to qualify for MU, including upgrades to hardware. I agree with BGladd. I think compliance should be rewarded.
http://www.mediworx.net
Lisa Henderson
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Lisa Henderson,
User Rank: Apprentice
10/21/2011 | 12:36:05 PM
re: Are EHR Incentives A Waste Of Money?
I agree. The regulations and mandates make it very hard for the smaller practice or organization to make gains. For larger entities they can afford to hire dedicated people, for others over-regulation seems to strangle the headways that could be made.

Lisa Henderson, InformationWeek Healthcare, contributing editor
AWESTERINK024
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AWESTERINK024,
User Rank: Apprentice
10/20/2011 | 5:59:22 PM
re: Are EHR Incentives A Waste Of Money?
There are so many IT mandates and evolving regulations that providers are being faced with that are making it difficult to truly determine the worth of MU incentives. For example a smaller practice may be spread to thinly to deal with an EHR implementation and security may fall to the wayside resulting in a breach. If this happens than any incentives are likely to be voided by fines or law suits http://www.vitalblog.com
Lisa Henderson
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Lisa Henderson,
User Rank: Apprentice
10/19/2011 | 10:34:38 PM
re: Are EHR Incentives A Waste Of Money?
I think any kind of technology is an investment because it does need to be constantly upgraded and maintained as the previous commenter noted. And adoption rates in any technology have that curve of the early, mid- and late adopters. Whether they should be incentivized, that's whole other issue.

Lisa Henderson, InformationWeek Healthcare, contributing editor
BGladd
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BGladd,
User Rank: Apprentice
10/19/2011 | 5:11:50 PM
re: Are EHR Incentives A Waste Of Money?
"merely rewarding health providers for minor adjustments to systems they have had in place for years."
__

Minor? MINOR? I work for one of the RECs (regionalextensioncenter.blogsp...). Upgrading to the Certified versions is ANYTHING but "minor."

Moreover, here will be a huge wave of providers attesting by the end of December 2011, a large proportion of whom will be relatively new users. Moreover, even the early adopters will have to continue to upgrade their systems as we move into stages 2 and 3 of MU.

Not that the initiative doesn't have its flaws (I'm certainly no unreflective HIT Cheerleader by any means), but let's be a bit more honest here.
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