Money Talks. Are You Listening?

July 15, 2009

The EHR stimulus has physicians and vendors alike buzzing. But are they asking the right questions, or just looking for a handout?


The 2009 economic stimulus package, which includes money for physicians who add EHRs, is already causing plenty of buzz, even though payments won’t start right away.

And that’s a good thing, for the most part. Practices that have long shunned even the possibility of adding an EHR now have a powerful incentive to do so - the stimulus package includes $44,000 in incentive payments to physicians adopting and using EHRs. The payment, which will come via Medicare and Medicaid beginning in 2011, is a powerful enticement, and an excuse-killer: It’s tougher to make the case that EHRs are too expensive when Uncle Sam has got his checkbook in hand.

And while it’s too soon to discern the impact the stimulus will have on adoption, it’s clearly stirring interest. Allscripts, for example, has seen a 300 percent increase in leads and a 26 percent increase in unique visits to its Web site since the legislation was signed in February, even with many details on requirements yet to be worked out.

Other vendors are seeing similar interest: “We’ve seen a number of clients who said ‘Call back in two years’… who are now back in purchase mode,” says Tom Cooke, a vice president of Eclipsys.

Money talks. And I’m happy the stimulus appears to be working. But a lot of practices seem to be asking the wrong questions or looking at things in an odd way - that is, they’re wondering how to play the system to get $44,000 when they should be wondering how to take this opportunity to modernize their practices and provide better care, and run with it.

Even as I write this, regulators are working out crucial details, defining terms like “meaningful use” and “certified” that are included in the language of the stimulus law. These regulations will at last make it easier to share clinical information among providers using different technology platforms and put the focus on actual improvements in care versus automation for automation’s sake. These are good developments in and of themselves. Physicians should be interested in these issues.

And yet the comments and questions I’ve gotten so far are disheartening. In a recent education session on the stimulus, some physicians pointed out that $44,000 doesn’t cover all the expense of some higher-end EHRs, so they still weren’t going to get one. Others pointed out that they, like 80-odd percent of American physicians, work in very small practices. They want the check but wonder if they could get a waiver from the requirement that they actually buy an EHR.

Folks, I know it’s tough out there. I get that fixing a broken system shouldn’t be your obligation. But these seem like the wrong questions. Your first questions should be along the lines of: “What benefits will my patients see?” and “What systems are out there that we can afford?” Not “Can you give me a little more?”

I’m put in mind of my son’s Montessori school, where they don’t reward children for good work with stickers or gum but with genuine interest and questions. The idea is to teach the inherent value of doing things well. I once made the mistake of offering my son quarters for doing small jobs around the house. Now every task involves a negotiation, and if he finds the price too low, he’s not interested in doing the work.

I’m also hearing many complaints that the incentive payments are really just bolstering the coffers of big tech vendors. GE is even offering bridge loans to physicians: It will loan you the money to buy its Centricity, and then you make the payments with stimulus package checks. Indeed, it’s becoming clear that it’s these big players in the space who can move rapidly to develop code consistent with new requirements that will increasingly dominate the marketplace. All this makes some itch: Why should the government help companies?

That, at least, is a principled objection, but it still seems like the wrong question. So companies benefit, physicians benefit, patients benefit. So what? Plus, from a practical standpoint, it seems a little late to complain. If physicians had already adopted open source technologies that worked together and helped patients without incentives, we wouldn’t be in this pickle.

It’s not a perfect world. But it can be a little better if we aim high, instead of spending time debating the best ways to get a few incentive dollars.

Pamela Moore is director of content and strategy for Physicians Practice. She can be reached at pam.moore@cmpmedica.com, or follow her tweets at twitter.com/pamelalmoore.

This article originally appeared in the July/August 2009 issue of Physicians Practice.