Casestudy: Meaningful Use-Now or Never
Whenthe Electronic Health Records pool was created in 2009, Congresspronounced that, all healthcare providers would have to make ameaningful use of the EHRs (Ferris Nancy 1). At that moment, Congressdid not define the meaning of meaningful use but left the task to theDepartment of Health and Human Service, and in 2010, the departmentreleased information on what is the meaning rather masked term(Ferris Nancy 1).
InMay 2011, the federal government commenced paying bonuses tohospitals and physicians that has started adopting and using EHRs. Upto 2016, hospitals and doctors may get as much as $44,000 and $63750from Medicare and Medicaid and earn millions of dollars if they areable to show that they have attained the set quality and have mademeaningful use of the electronic health records. It is estimatedthat, the cost of providing these incentives to hospital, clinicians,physicians and doctors will cost the federal government at least $27billion by 2016 (David, Kibbe 1). That withstanding, providers inhealthcare have until 2016 to implement the EHR systems, and it isexpected that, the EHR will transform the delivery of healthcare inUnited States and improve quality of healthcare and efficiency.
Tomake the matter more complicated for the hospitals and physicians whoare loath to implement the HER program now, the government incentiveis a double –edged sword (Ferris Nancy 1). Failure to adopt theprogram now means that, hospital and doctors will forego thousands ofdollars, and will invite hefty penalties by way of decreased Medicaidand Medicare disbursements. If it is established that a hospital ordoctors has failed to meet the meaningful user mark, their paymentswill be decreased by 1% in 2015, which will increase to 2% in 2016,3% in the following year and up to 5% in 2020 (Ferris Nancy 1).
Advantagesof Implementing the EHR Now
Oneof the main advantage of implementing the HER program now is the factthat, they will benefit from a thousands of incentives from theFederal Government by way of increased Medicaid and Medicarepayments. Even though every clinician’s and doctor’s individualsituation will determine if or not they opt to adopt the EHR programnow or in the future, the unique bonuses provided by the Federalgovernment in the stimulus package (Ferris Nancy 1). This means thatthe more reluctant physicians are to adopting HER programs the morethey lose.
Underthe current law, clinicians are permitted to write-off up to $250000of electronic health records costs in the first year of adoption,even if such arrangements are met through the lease agreement (FerrisNancy 1). It is a form of software tax deduction that will go a longway in lowering the cost of adopting and implementing the HER system.In addition the economic stimulus program offers for an additional50%bonus tax deduction. This is a tangible and substantial value forall clinicians that replace and adopt capital equipment andsoftware(Ferris Nancy 1).
Itis also evident that adopting the EHR systems now will expedite thetime that is required to implement the program. There is no doubtthat adopting the HER system now will be much more cheaper than whatit might be in the coming days (Ferris Nancy 1). This is mainly dueto the fact that it will pay for itself through reduction in theadministrative costs and rising revenues. Even if administrators maybe loath to commit huge investments in the systems, lease financingcan start earning incentives and bonuses.
Oneof the major issues that have emerged relating to HER systems adoptedin from 2009 to date is whether they meet the set standards by theDepartment of Health and Human Services. Choosing the most apt EHR isnot a simple process and in many cases it consumes a lot of time. Italso calls for a huge budget outlay that drains immense resourcesfrom the healthcare providers (David, Kibbe 1). This means that theprocess of adopting and implementing an HER program needs to be donewithout room for big mistakes. In this light, health care providerswho had and who have already adopted HER systems in their institutionmay find its difficult to make adjustment due the changes that havebeen necessitated by the new standards set by the HHS (David, Kibbe1).
Theother disadvantage of implementing an HER program now is the factthat hospitals and physicians may not have adequate time to conduct athorough research process, that can enable them to create ashort-list of systems, carry out demonstrations with vendors,negotiate terms, check references, conduct a thorough trainingprocess (Masha, Paschal 2). It is important that hospitals anddoctors are able to make agreements with vendors that guarantee thatthe HER systems will comply and meet the standards that have been setby the HHS.
Thereis also the problem that doctors will not be in a position to make anappropriate judgment on the cost of the HER system, at least for thenext twelve months. This has been caused by the confusion that existsin the certification process that is meant to coerce vendors tomodify their systems (David, Kibbe 1). The Federal Government hasalso conducted pilot studies but due to the specific situation inevery healthcare setting, it is not yet clear what it will costclinicians and physicians to employ the HER system “meaningfully”.
Manyclinicians and hospitals can not conclusively foresee what is likelyto happen to their future revenues and operations that will determinethe amount of resources they can put into purchasing the HER systems(Ferris Nancy 1). There is the unsettling prospect among physiciansthat the fact that the HHS’s replacement criteria for certificationformulated by the CCHIT, mean that the current vendors who have beensupplying HER systems may encounter diminishing influence in thecoming days. Invariably this will open room for new innovation thatmay prove to be less costly and perhaps even web based technologiesthat will inevitably render the current ones moribund (Ferris Nancy1).
Carrotand stick Approach
Eventhough it is yet to be seen whether the penalties on will have anyeffects on clinicians. Nonetheless, it is important to take note ofthe fact that meaningful –use execution might prove overlycomplicate and arduous for physicians in medium and small sizepractices. EHR system will inevitably cost them much more onproductivity and money that what is expected to be achieved throughthe incentive program (Ferris Nancy 1). Congress might not slogenough will to punish clinicians who opt to forego the program thatwill obviously pay lower fee schedule. Many questions also arise, forexample what would such a penalty accomplish other than forcingmajority of the primary care clinicians into retirement or in otherlarge organizations where they are underpaid and are not accorded therespect that they deserve. Penalties might also spark a backlashfrom clinicians and physicians bodies and patient advocacy groups(Ferris Nancy 1).
Eventhough the Budget Office has stated that physician might neverrespond to the Federal Government’s incentives in the proportionsthat is expected, and only a penalty can coerce adoption, manyphysician are conscious of the fact that Congress has always beenloath to punish them for any conduct (Ferris Nancy 1). In this vein,it sounds more convincing to state that, the carrot and stickapproach will yield very little returns. Incentive offered to healthinstitutions to roll up doctors in the 1990s ended in total failure,and this may be just another case of empty threats.
DavidC. Kibbe. ShouldDoctors Reject the Government`s EHR Incentive Plan. Family PracticeManagement.2010, 17(2):8-9. Available at:http://www.aafp.org/fpm/2010/0300/p8.html
Ferris,Nancy. " `Meaningful Use` of Electronic Health Records,"HealthAffairs .2010.Available at :http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=24
HealthcareInformation and Management Systems Society (HIMSS). KeyIssues in EHR Adoption and Sustainability Whitepaper.2008. Available at:http://www.himss.org/files/HIMSSorg/content/files/EHR_Adoption_Sustainability080608.pdf[Accessed on 23.7.2015]
Masha,Paschal. BeyondModular Electronic Health Records: Meeting Your Meaningful UseAttestation Goals.Truven Health Analytics. 2013. Available at :http://truvenhealth.com/portals/0/assets/HOSP_12837_0713_MUQM_WP_WEB.pdf[Accessed on 23/7/2015].