Monday, September 24th 2012

Maybe This Will Promote Adoption

Despite meningful use bonuses from CMS, electronic medical records remain highly contentious amongst physicians and their implementation remains sluggish.

The most recent CDC data would seem to be encouraging for EMR adoption, with EMR use (finally) passing 50%.

Too bad there is more to the story.

If you look at adoption rates for so called “fully functional EMRs,” the adoption rate remains in the low teens (full data for 2011 is not yet available). So why is there an almost 4-fold discrepancy between “any EMR” and “fully functional EMR”? If EMRs are so great, why does the government have to essentially “bribe” physicians to adopt them through incentives such as the meaningful use incentive program? Why is this so important to them that they didn’t even wait for the healthcare affordability act to implement this “incentive”?

The effect of EMRs on quality care measures remains dubious and the effect on productivity, and thus presumably, income is likely even more in question. Physicians skeptical of the adoption of electronic records should probably pay attention to a new analysis from the New York Times. Although some of it attributed to questionable practices it appears that the implementation of electronic medical records is associated with increased billing and reimbursement.

Over all, hospitals [and presumably physicians] that received government incentives to adopt electronic records showed a 47 percent rise in Medicare payments at higher levels from 2006 to 2010, the latest year for which data are available, compared with a 32 percent rise in hospitals that have not received any government incentives, according to the analysis by The Times.

[...]

Some experts blame a substantial share of the higher payments on the increasingly widespread use of electronic health record systems. Some of these programs can automatically generate detailed patient histories, or allow doctors to cut and paste the same examination findings for multiple patients — a practice called cloning — with the click of a button or the swipe of a finger on an iPad, making it appear that the physicians conducted more thorough exams than, perhaps, they did.

[...]

Many hospitals and doctors say that the new systems allow them to better document the care they provide, justifying the higher payments they are receiving. Many doctors and hospitals were actually underbilling before they began keeping electronic records, said Dr. David J. Brailer, an early federal proponent of digitizing records and an official in the George W. Bush administration.

There’s no doubt that it’s easier to check a set of boxes than write out a detailed review of systems on a chart. I’m inclined to believe that more thorough documentation is the result of the ease with which the documentation can now be made and not a matter of documenting unperformed history and exam. It may indeed be roundabout evidence of increased productivity that we’ve been waiting for.

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