What’s in the Stimulus Plan for You?

April 1, 2009

The Obama administration is putting serious money behind its determination to make all medical records electronic. Has the time finally come to get that EMR?

The Obama administration has made it crystal clear that physicians are expected to get on board the technology bandwagon. And the government is willing to pay you to do it. During the campaign, Obama vowed to spend $10 billion annually over the next five years on health IT.

Of course, we’ve heard such excitement before. Former President George W. Bush saw the promised land of cheaper and better health through technology and promised to get EMRs in place for all Americans by 2014. Most physicians, though, still don’t use EMRs, and questions about interoperability continue to linger.

But Obama is putting our money where his mouth is. The just-passed economic stimulus package commits $44,000 to $64,000 to physicians who acquire and can show “meaningful use” of a “certified” electronic record over the next five years. Payments are made as a percentage of Medicare charges. “That could really stimulate the market,” says Rob Tennant, a senior adviser with the Medical Group Management Association’s government affairs office.

And if it doesn’t, the government will get tougher. After the five-year incentive period expires, physicians who still aren’t using a certified EMR will see their Medicare payments reduced - by 1 percent in 2015, followed by deeper cuts in subsequent years.

There is good reason to hope that this move will spur adoption - and cost savings later on. A Congressional Budget Office analysis reports that the “incentive mechanism would boost … adoption rates to about 70 percent for hospitals and about 90 percent for physicians” by 2019.

Sixty-eight percent of physicians say they’d be likely to participate in a pay-for-purchase program, according to a survey conducted by Allscripts - an EMR vendor positioned to win big should physicians follow through on those inclinations. Take our Tech Survey for a chance to voice your opinion on the subject (and a shot at winning $500.)

And the similarly structured e-prescribing incentive program - bonuses followed by penalties - seems to be working. Thirty-seven percent of the physicians surveyed by Allscripts already are participating.

So, can we expect a boom in EMR purchasing?

It’s unclear. Skeptics suggest that even the shocking $44,000-and-up per-physician payment may not be enough. The price of the software is “not really the issue,” says Evan Steele, CEO of SRS Soft, a product positioned as a less complex, hybrid alternative to EMRs. “The price is dwarfed by the problems it [an EMR] causes the office.” If a specialist billing $750,000 a year loses just 5 percent of her productivity once she has to start monkeying around with templates or a keyboard, the EMR can cost her over $162,000 over five years, Steele argues.

Others, of course, disagree. “If it’s implemented properly and staff and physicians are properly trained, [an EMR] almost always increases productivity,” says Tennant. And many promise that the efficiencies offered by electronic records will reduce healthcare costs, over time, by billions of dollars a year. The biggest beneficiary of this savings will be the taxpayer since governments (federal, state, and local) spend more on healthcare than anyone else.

This savings is the big goal, of course, but that can only happen if systems are integrated well and used heavily. “It’s more than saying let’s put in a large [EMR] system. … Putting in the technology itself doesn’t necessarily provide all the benefits people are looking for,” notes John Shagoury, president of Nuance Healthcare.

The Holy Grail for the government is making it possible for doctors to access every patient’s records as needed, regardless of where the patient was treated, or by whom, and notwithstanding the physician’s EMR vendor or the patient’s insurance carrier. A gastroenterologist in Boca Raton using Allscripts should be able to see the results of his Medicare patient’s colonoscopy, even though it was done six months ago at a practice in Carol Gables that uses Cerner. No need to reorder the test, or even to wait for the records. To get there, we need all the EMRs speaking the same language.

The stimulus package might winnow out some players, perhaps making it easier to achieve interoperability. To get the incentive, physicians have to use a “certified” EMR - presumably by the Certification Commission for Healthcare Information Technology (CCHIT). Many smaller vendors - unable or unwilling to pay CCHIT to certify their systems, and annoyed by what the commission does and doesn’t measure - don’t have that certification.

Still, if getting a CCHIT-certified product is the only way to get $44,000 or more, my money is on the CCHIT-certified vendors.

Bottom line: There is no requirement to get an EMR, but the stakes are getting higher and the number of vendors will likely get thinner. Let the shopping begin.

Pamela Moore is director of content and strategy for Physicians Practice. Moore has been writing for physicians on practice management issues for 10 years and she is a recognized speaker and commentator on healthcare management. She can be reached at pam.moore@cmpmedica.com.

This article originally appeared in the April 2009 issue of Physicians Practice.