Printer-friendly format

Dr. Keith F. DeSonier, Louisiana Medical Society's Louisiana Medical Political Action Committee

Physicians who implement electronic health records could receive up to $44,000 in increased Medicare reimbursements over five years, but that still falls far short of the costs to move to the new systems.

"They're saying, 'You've got to get out of the cottage industry and into the world,'" said Dr. Keith F. DeSonier, chairman of the Louisiana State Medical Society's Louisiana Medical Political Action Committee. "That's fine. I have computers everywhere, for scheduling, accounting, and so forth."

On the business side of a practice, computers have really helped, and the return on investment and improved efficiencies are measurable, DeSonier said. It's on the clinical side where the problems arise.

Although supporters can point to studies that show electronic health records reduce errors, improve patient care and lower the cost of healthcare, there is less evidence showing that the systems improve physicians' bottom lines.

That's important because the systems are not cheap.

A large practice, with 10 physicians or more, can spend $500,000 on a system, DeSonier said. A solo practitioner like DeSonier can spend $60,000 in a heartbeat.

"We couldn't afford it because of the reimbursement rates," DeSonier said.

The total cost includes the initial cost of the equipment, installation, transitioning paper records to electronic, maintenance fees and the cost to adapt to changes that the insurance companies or government make in rules and regulations, DeSonier said. While a larger practice may have an IT person on staff, a small practice, and most of the state's practices are small, has to hire a programmer at around $200 an hour to do maintenance.

A story published by HealthLeaders Media quoted one Arizona cardiology practice, with seven doctors, as spending $138,000 just to scan its paper records.

That doesn't include the thousands of dollars in programming costs incurred if a practice's proprietary system cannot communicate effectively with someone else's proprietary system, DeSonier said.

The stimulus bill's incentives don't include a large payment to help purchase an EHR system, DeSonier said. Instead, physicians get the incentives a little piece at a time, through an additional reimbursement for each Medicare patient, over a five-year period.

A solo practice might spend $60,000 on a system and get back only $30,000 through incentives, he said. Meanwhile, if physicians don't get the EHR systems in place by 2015 they will be penalized through lower reimbursements.

Medicare fees for non-EHR physicians will be cut by 1 percent in 2015; by 2 percent in 2016; and 3 percent in 2017 and beyond. The U.S. secretary of Health and Human Services can cut reimbursements by 5 percent starting in 2018 if less than 75 percent of physicians have the systems in place.

"They have a good philosophy but there's no definitive study that shows medical records recover expenditure right now," he said.

Maybe as advances are made, the systems will become less expensive and the cost to move from paper to electronic records will become cheaper, DeSonier said. But what happens if the practice has to buy a new EHR system.

"That's the part where as a business person, I say, 'Wait a minute,'" DeSonier said. "I got tight margins already. I got lower reimbursements every year, and you're going to penalize me if I don't change, but yet you don't help me afford this thing.'"
Louisiana's hospitals may be in a little better position.

Rebecca Bradley, the Louisiana Hospital Association's director of Rural Health Programs, said the last several years have seen a tremendous movement among hospitals toward implementing electronic health records.

Larger hospitals and rural hospitals, thanks in large part to state and federal programs, are leading the charge, she said. The trend will continue with or without the stimulus bill.

Bradley said it's too early to tell where the stimulus money is going or what Louisiana's share will be.

"The only thing I can say with any level of certainty is that, yes, there is going to be improved access to dollars for HIT adoption," Bradley said.

That money will be funneled through the Louisiana Department of Health and Hospitals and through the federal Centers for Medicare & Medicaid Services, Bradley said. There may also be grants through the federal Agency of Healthcare Research and Quality and the National Institutes of Health.

However, the loans and grants coming through the state will require a 50-50 match, meaning that providers will have to come up with the other half of the money, whether privately or with state help, Bradley said.

Tags:

Centers for Medicare & Medicaid Services, electronic health records, health information technology, Louisiana Department of Health and Hospitals, Medicaid, Medicare, National Institutes of Health, stimulus bill, U.S. Department of Health and Human Services

Login and voice your opinion!

Do you know someone else who would like to see this?
Your Email:
Their Email:
Comment:	(Will be included with e-mail)