The Government’s Credibility Problem on EHR Incentives...and Everything Else

Posted by: Peggy Salvatore

Have you heard the old joke: I’m from the government and I’m here to help?

Oh, you have? Well, apparently, so have a lot of other people.

So, when CMS put out a 19-page letter to the state Medicaid agencies on August 17 about paying 100% of costs for EHR implementations and associated activities, it apparently didn’t change anybody’s mind about either the government’s willingness or ability to live up to its offer.

A look at the results of a HealthData Management poll on August 10 and August 20 shows that the needle doesn’t move on trust in Medicare or Medicaid to pay the EHR meaningful use incentives as promised. Interestingly, only 25% believe CMS will pay for their electronic health systems under Medicare and Medicaid incentive programs. That’s only a bit higher than the percentage of people who have faith in Congress – about 20% according to Gallup polls.

Here are the polls:
HealthData Management Poll: Results
Do you believe that Medicare and Medicaid programs will pay EHR meaningful use incentives as promised? August 10, 2010

Yes, both programs will pay in full for those who meet criteria. 25%

25%

Medicare will pay as promised, but Medicaid won't. 23%

23%

Both programs won't pay as promised. 52%

52%

 

Do you believe that Medicare and Medicaid programs will pay EHR meaningful use incentives as promised? August 20, 2010

Yes, both programs will pay in full for those who meet criteria. 25%

26%

Medicare will pay as promised, but Medicaid won't. 22%

23%

Both programs won't pay as promised. 52%

52%

 

What do these poll results mean, or more specifically to our concern here, what do they mean for the uptake of electronic patient records?

I figure it means a few things.

One, it means that if we think people will install an electronic health record system because they are going to be reimbursed by the government, that might not be an accurate assumption. As this poll shows, more than half of the respondents of this poll do not believe they’ll ever see the money. So, the incentive program is flawed due to public distrust of the government living up to its promise.

Two, healthcare providers will put electronic patient record systems into their environments for all the right reasons – if they believe EHRs improve patient care, reduce their costs of doing business and make their workflow easier. In other words, providers will make a business decision that electronic patient records will pay for themselves.

If a good electronic patient record system lives up to its potential, ideally, it will pay for itself many times over.

Forget government incentives. When providers are convinced EHRs are better than paper records, the transformation will happen because it is the right thing to do. And it is up to the EHR vendors to create products that have real value, and to communicate that value to providers. Let the free market – where consumers chase goods that have inherent value and improve their lives - do the rest.

Comments

[Jonena]

Wow, so 74% are doubtful that the gov't will pay as promised. It's a sad day in America!

[Mike Koriwchak MD]

Peggy you nailed it right on the button.

Why should we trust a government that attacks us at every turn with ever-decreasing payments, ever-increasing regulations, and a health care reform bill that will destroy the practice of medicine in this country as we know it?

[Michelle W]

I think everyone's starting to acknowledge the fact that while there are many laudable goals of meaningful use, what matters to most physicians is the "practical use" (coined over at the EMR & HIPAA blog) of the product. Perhaps when and if an actual incentives check is received, the program will pick up steam, but the important thing is that physicians pick a product that actually matches their practice needs, not just satisfy a checklist crafted by the ONC.

Ironically, choosing a best fit product and learning to use it well will probably lead to better MU compliance than blindly choosing a product with the HITECH rubber stamp.

[Jonena]

Michelle, you are spot on! Until buying anything, be it software, hardware or office furniture, the product has to fit the needs of the practice. Otherwise, in the case of EMR or EHR, you're simply spending money to hopefully get reimbursed someday. True improvements in patient care should trump money, in my humble opinion.

[Jonena]

Peggy, Wow, based on the number of hits this post continues to get, you really hit a nerve with this topic! Keep up the good work, gal. We need to keep people thinking so they will make informed decisions in the future.

[logan]

"Forget government incentives. When providers are convinced EHRs are better than paper records"

Better for whom? I am not sure the social welfare equates to private welfare in this case. While the math does not add up for individual providers, it probably does for the system as a whole. Even if it does make economic sense for providers to invest in EHR there is no guarantee that they will do it in a manner that will improve overall system efficiency and quality. You need to provide a much deeper rationale and supporting evidence to back up your statement.

[Peggy Salvatore]

Hi Logan, Yes, I agree with you. There are studies about how much money we'll save, there are studies about how much this is going to cost us - we need to know more than we do to back up these statements. And again, you are right, the social cost/savings are different from the practice cost/savings. We'll know a lot more about what works when we have more experience to draw on. When practices can do business better with EHR than without it, it will just make sense to move toward integrating the technology. Some of them will do it better than others, but hopefully we'll get the education to them so the execution is done well. Right now, we are a little early in the curve to have good answers. Thank you for your response.