Health IT requirements that few doctors and hospitals can meet

Saying that you’re going to spend billions of dollars to modernize the country’s health IT system makes for good press.

But, as many doctors and hospitals a finding out, the devil is in the details.

As it stands, the requirements to receive some of that money are so onerous, that it’s unlikely that most will qualify for the payments.

Maybe that’s what the government wanted all along.

According to a recent article in the New York Times, “the eligibility criteria proposed by the Obama administration are so strict and so ambitious that hardly any doctors or hospitals can meet them, not even the most technologically advanced providers like Kaiser Permanente and Intermountain Healthcare.”

Think about that. California’s Kaiser Permanente is among the most technologically savvy physician groups in the country. If they can’t meet the requirements, what are the chances that independent solo and small group practices can?

It’s difficult enough to implement an electronic medical record system. Compounding that is the fragmented nature of the EMR industry, which leads hospitals to adopt different systems that may not all talk to one another.

Small group practices have it even tougher. With their operating margins already slim from decreasing reimbursements and rising overhead, they have little financial resources to make the transition.

And when the incentives turn into penalties in the coming years, I don’t see how these practices can survive on their own. They’ll have no choice but to be bought out by hospitals or integrated health systems.

Again, that also may be what the government ultimately wants.

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  • stargirl65

    “They’ll have no choice but to be bought out by hospitals or integrated health systems.”

    I’ve been in both situations. I am currently in solo practice. I run things better than the MBA’s and Health Manager’s ran things. They were all about managing things but never actually did anything. They simply added layers of bureacracy without improving the delivery of care or even improving the bottom line.

    Their advantages include power to negotiate with health insurers (which they never wielded), deeper pockets, the ability to get better prices on purchases (which they never utilized), the ability to offer more services since many doctors will be utilizing them.

    BTW- I have been using and EMR since I opened my own office in 2000. It does not meet their requirements even though it is CCHIT certified.

  • Michael Kirsch, M.D.

    A few years back, our practice attempted to participate in the government’s PQRI ‘quality’ initiative. It was a hassle to set up, and we never got a dime back for doing so. We called but could never get any feedback on our effort. (For a free ‘stress test’, try calling Medicare to get useful information from a living breathing human being!) We abandoned our participation in the program, which has absolutely nothing to do with medical quality.

  • Margalit Gur-Arie

    Here is the strangest and most counter intuitive part: it may actually be easier for a small private practice to meet the requirements than for a large hospital to do the same. Deploying one of those certified packages in a small practice takes a couple of months and a few thousand dollars. In a hospital, just CPOE can take years, not to mention connectivity, documentation, CDS, etc., and many millions of dollars.

    I also suspect that there is a covert intent to herd independent docs into large groups and hospitals, and not just through technology requirements, but also through the proposed reforms for payment models. Frankly, I think this is a mistake.

  • GlassHospital

    >”I also suspect that there is a covert intent to herd independent docs into large groups and hospitals, and not just through technology requirements, but also through the proposed reforms for payment models.”

    From #3 above. I agree that the tendency will be toward mass consolidation. I doubt that it’s party of any “covert intent;” rather, I think it falls into the “unintended consequences” category of health care reform.

    Politically, leaders from all ends of the spectrum must support the right to stay in private practice. To say otherwise is simply un-American.

    This post is intriguing–if no entity, large or small, can meet the “meaningful use” criteria, how is it that these informatics companies (e.g. Athenahealth) can market themselves as “guaranteeing” that their customers will get the payment?

    -Dr. John

  • BladeDoc

    What a shock! A broke government promises to spend a bunch of money if you can make it over this imaginary hurdle. Everybody starts jumping and belatedly asks “how high!” Almost there. Almost there, just keep jumping.

  • Wellescent Health Forums

    For the business savvy, enabling private practices and organizations to meet the “meaningful use” criteria around EHRs would seem to be a solid business opportunity. Those that can provide a complete solution and guide health organizations through the adoption process will likely have a long string of clients. Though their products might not meet the criteria in the version 1.0 solutions, getting access to the federal dollars will likely be intriguing enough that these companies will create compliant solutions in short order.

  • fortitude

    Thank you for this article, all this EMR stuff sounds great, but so do a lot of things, when put in actual practice it just doesn’t work, because there are so many companies, a true EMR needs to be able to completely integrate with other EMR’s, in the same way a verizon phone can call an ATT phone, a yahoo email can be sent to hotmail. EMR’s simply cannot do these fundamental things, I personally don’t think the penalty will be as bad as the lost production time, in integration, It makes sense to wait it out until our hands are forced, the tech is much better as the years go by and will be much cheaper

  • Indiepsychnp

    The only way a nurse practioner can qualify is by having a patient population that is at least 30% Medicaid. In psychiatry, with a student loan balance of $140K they have got to be kidding. I make far more in private practice using an online billing service not having a group medical practice take 40% of my net. CMS missed the boat on the role of NPs altogether. Which doesn’t matter because here in psychiatry at the bottom of the RVU per time spent food chain that still won’t pay the bills. I don’t NEED an inhouse EHR as a solo practitioner when there are online services for $32.00 a month that streamline billing….

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