Case in point: Community Health Network, a five-hospital system in Indianapolis, is now installing a GE Centricity EMR in the offices of its 175 employed primary-care physicians. But, except for some private practices managed by its management services organization, says Community Health Network CEO William Corley, the system won’t donate EMRs to any area doctors until after it installs a new enterprise EMR in its hospitals this year. Meanwhile, he notes, the hospital plans to provide a Centricity “EMR lite” to non-employed specialists so they can receive lab results and communicate online with the employed doctors.
Similarly, St. Luke’s Health System in Kansas City is rolling out EMRs to its own medical group and offering the RelayHealth secure messaging system to community doctors. Debe Gash, St. Luke’s CIO, sees hospital gifts to private practices as the exception. It’s tough for them to find the money, she says, “given the reimbursement climate and low operating margins.”
But how much will they pay?
Healthcare systems that are donating EMRs often pay the maximum allowable 85 percent of the software cost. But that still leaves a big investment for you.
Consider Memorial Hermann Health Network Providers, an IPA affiliated with Memorial Hermann Hospital in Houston. Using hospital funds, the IPA plans to help up to 1,300 of its member physicians — all of whom have agreed to participate in a “clinical integration program” — to buy the eClinicalWorks EMR. Scott Fenn, CEO of the network, says that 132 doctors are already implementing or using the EMR, and he expects 400 to be up and running within three years. Other discounts also may be available to early adopters of the eClinicalWorks EMR.
The IPA, which hosts the program itself and provides technical support, starts with a needs assessment of each practice. While doctors select their own hardware and get discounts through the IPA, they’re told what the minimum computer requirements are. Some practices have felt taken aback by the equipment cost, which averages $5,000 to $7,000 for a soloist, Fenn says.
Because the hospital cannot legally pay for ongoing support, the cost is bundled into the monthly fee of $325 per physician, plus $75 for eClinicalWorks’ practice management component, if a practice chooses to include that. So, participating doctors are paying up to $400 a month.
Plastic surgeon William Riley Jr. of Sugar Land, Texas, an EMR adopter, feels that’s a reasonable charge. And it’s not atypical for hospital-provided EMRs.
The Butler Health System in Butler, Pa., is charging private-practice doctors $500 a month for hosting and supporting an Allscripts EMR. It’s paying 85 percent of the cost for the software, which is also being rolled out to its 30 employed physicians.
The hospital decided to offer only one product because it believed that would be the best way to improve community health, says Mike Bush, Butler’s vice president and chief strategic officer. He also points out that the system wanted to provide an EMR to doctors before one of its competitors did, and that physician job candidates are increasingly demanding that the hospital give them an EMR.
Payer subsidies
Health plans, like hospitals, are still rather timorous about subsidizing EMRs for doctors. Most of the technology donations from payers have been e-prescribing programs, which promise a faster and surer bang for the buck via increased generic and in-formulary prescriptions.
Yet there are exceptions. Nine percent of health plans include incentives for EMR adoption in their pay-for-performance programs, and some plans provide other kinds of incentives. Here are a few of these programs:
Uncle Sam and health IT
The Bush Administration started promoting health IT in 2004. A couple of years ago, CMS had its quality improvement organizations in every state help a limited number of small practices choose and acquire EMRs. And in a three-year pilot program launched by the Department of Health and Human Services last year, 1,200 small- and medium-sized practices in 12 markets are being given incentives for acquiring EMRs. The Obama Administration is continuing to push health technology by including health IT in the economic stimulus package, as mentioned earlier. Since Jan. 1, 2009, CMS has also been paying a 2 percent bonus to physicians who prescribe electronically, using either a certified EMR or standalone e-prescribing software. That incentive can contribute several thousand dollars per doctor per year toward covering the cost of an EMR.
