The obstacles behind the government’s push for electronic health records. “Paying for the network will be the first major hurdle. Many cash-strapped hospitals and small-practice doctors have no interest in footing the bill for a medical Internet. One key reason is the mismatch between costs and savings: While health-care providers bear the cost of tech investments, Medicare and private insurers reap almost all the savings. Pamela R. Kushner, a family medicine physician in Long Beach, Calif., says the estimated expense to upgrade her three-doctor office is $130,000. ‘I’m supposed to take the burn for the initial outlay, the installation, and the transition? No, thank you,’ Kushner says.”

With the upcoming cut in Medicare reimbursement, expect fewer physicians to take up the EHR cause.

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  • Anonymous

    This is true. What is also true is the dismal track records some of the companies that have sold the EMRs have had for longevity–some have folded leaving doctors with costly and unsupported systems that have to be replaced, again at a large outlay. Six figure quotes are common for small offices without a hardware package or a support program; that can annually add tens of thousands of dollars to the cost.

    This is one more example of the insurance industry and Medicare foisting the costs of their claims apparatus on the small providers, with little prospect of a return to those making the outlay. Telling the public that this will improve patient care–as our President has done–is at its best over-promising and misleading. I think it is more likely a boondoggle for the companies selling processing services, computer hardware and software, and data miners who sell analysis packages to the government and industry. There is comparatively little benefit to the practitioner.

    If Medicare wants this so badly, let them pick up the cost. Forcing it on the small practice owner is really giving one more reason to opt out of Medicare altogether.


  • Anonymous

    Funny you should say that, CH. CMS has already laid out a good chunk of money for the VA’s EMR (Vista). Due to a timely FOIA request, the source for Vista was released last year and is currently going through some beta testing. You will be able to get it for pretty short money. There are already companies tooling up to commercially support it, but even if those companies go under, with access to the source code you will NEVER be left out in the cold again with abandonware.

    I have serious trepidations about an “national” health network. I’d much rather that CMS/OASIS come up with a standard format for medical records (like HL7, for example) that can be copied to/from a flash drive. Much more secure, in my opinion. Given the number of security breaches and just plain stupid things that people do, putting the medical information of every citizen online with access to all is just not wise.

    Last, let’s not forget that it isn’t just Medicare reimbursement that’s going to be cut. One of Medicare’s methods of reducing payouts is by manipulating RVU’s. Any changes to the RVU’s will result in similar payout changes by any carrier (like United Healthcare) that ties their rates to Medicare RVU’s.

  • dr john

    Note that EHRs are ultimately linked to pay-for-quality-performance. My grievance with “quality” is that it’s just a proxy for patient demographics: my patients from prosperous zip codes have far better A1Cs than my patients from poorer zip codes.
    My future office: Wealthy zip code, second floor walk-up, all communication via email. My quality ratings will be stratospheric.

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