Thomas Lew is a Product Manager focusing on the execution and operational side of the product development process. He is responsible for building and maintaining the product roadmap, overseeing the issue escalation process, and documenting product requirements. Prior to his tenure as a Product Manager, Thomas served as Technical Support Manager, working directly with customers to address technical concerns. He earned a BS in Computer Science from Rutgers University.
I have a confession. I am a travel snob. When I travel, I want to travel with as much luxury and as many conveniences as possible. You may ask yourself, is there really a difference between Boarding Group 5 and Boarding Group 1? Yes—absolutely. Sitting in that marginally larger seat and sipping that complimentary pre-flight beverage makes the next several hours of claustrophobic internment so much more bearable.
Recently, returning home from the annual meeting of the American Academy of Orthopaedic Surgeons (AAOS) in Las Vegas, I faced a travel-snob dilemma. I had a six-hour red-eye flight back to New Jersey, but not enough status with the airline for a free upgrade. The question was, was it worth paying for the upgrade to have the extra comfort and the extra sleep, and maybe a more productive next day at work? Or should I just keep my money in my pocket, grin and bear a middle seat, and suffer the jet-lag consequences? After all, I would end up at my destination either way. As so often happens, I was well aware of the problem, but I wasn’t sure if I was willing to devote resources to the solution.
I heard similar dilemmas voiced by many of the physicians as I walked the floor at the AAOS conference: “The experience with my current EHR is a nightmare. It’s so hard to use that I’m spending hours every evening just finishing up the work I should have done during the day! When I do try to use my EHR during the visit, it interferes with my interaction with the patient. Why do I have to use this thing if it creates so many problems?”
Just like budget travelers sitting in the back of the plane next to the bathroom and looking up at first class, many physicians with bad EHRs end up thinking: “I should have spent more time considering what a less-than-ideal solution would cost me, not just the price tag. It would have been worth it to invest in an option that works for me.” The cost of saving on an airline ticket is only a few uncomfortable hours and maybe a bit of jet lag. But ask yourself this: What is the cost of choosing the wrong EHR?
HHS has made it official—Stage 2 of meaningful use will be pushed back to 2014. The announcement by HHS Secretary Sebelius came as no surprise, following as it did the recommendation made by the HIT Policy Committee and the endorsement by ONC head Farzad Mostashari. The change only affects providers whose first incentive payment year is 2011, since they are the only providers who would be subject to Stage 2 regulations in 2013 had the delay not been implemented—everyone was already entitled to 2 years of meaningful use at Stage 1.
What I find interesting about all the hoopla that has accompanied the announcement is the spin the government put on the decision. According to the press release from HHS, “To encourage faster adoption, the Secretary announced that HHS intends to allow doctors and hospitals to adopt health IT this year, without meeting the new standards until 2014. Doctors who act quickly can also qualify for incentive payments in 2011 as well as 2012.”
Isn’t it a bit late for a provider to decide to adopt health IT this year? In reality, this announcement is too last-minute to change any adoption-related behavior or to accelerate EHR adoption. The announcement continued, “Perhaps most importantly, we want to provide an added incentive for providers attesting to meaningful use in 2011.” Apparently, the goal is to accelerate attestation rather than adoption—to encourage physicians who were already using certified EHR technology in a “meaningful way” to attest and to collect an incentive payment this year, instead of holding off attesting until 2012. This would create a potential PR benefit for the incentive program, which currently boasts nearly 115,000 registered providers, but reports that only 10,155 (9%), have successfully attested.
The benefit of the schedule delay accrues only to the early adopters, who now can earn 3 years of incentives under the less stringent requirements of Stage 1 (only, however, if they are willing to forego their 2011 Medicare ePrescribing bonuses—not a worthwhile trade-off for high-revenue physicians with large Medicare volumes). In its statement, HHS acknowledged the pushback from providers regarding how challenging even the Stage 1 requirements are. Perhaps, it would truly spur program participation and EHR adoption if all providers—not just the early adopters—were entitled to 3 years of meaningful use under Stage 1 rules. Also, if CMS has so little confidence that physicians will succeed at Stage 2, shouldn’t it reconsider how much it plans to raise the bar?
I spent the last few days attending the annual conference of the Medical Group Management Association (MGMA) in Denver, where there was a lot of talk about the financial challenges practices are facing and about the government’s EHR incentives.
Robert Tennant, MGMA’s Senior Policy Advisor, acknowledged that few groups will be eligible for the incentives when the government’s program begins in 2011. According to William Jessee, M.D., President and CEO, the vast majority of practices do not currently have any type of EHR, and despite being pressured by vendors that the time to purchase and implement one is now, physicians are reluctant to commit the resources necessary to do so. He attributed this to the financial effects of the recession—an unprecedented negative growth in practice revenue that is resulting in decisions to postpone capital investments. Add to this the pervasive confusion surrounding the incentives themselves, and the forecast is for wholesale inaction.
All of this has reinforced my belief that it is more important than ever for physicians to make good business decisions, and to do everything they can to enhance—or at a minimum, preserve—productivity. Not only will practices be faced with the financial pressures and declining reimbursements cited by the MGMA, but additional factors will make productivity critical. The impending flood of aging baby-boomers and the newly insured (through healthcare reform legislation)—coupled with a growing physician shortage—will swamp the healthcare system. This increased demand for care creates an opportunity, but only physicians who can leverage EHR technology to boost their productivity will really keep their heads above water.
We are very encouraged that the Voice of the Physician Petition has been acknowledged at the highest levels of government. After HHS (Department of Health and Human Services) Secretary Kathleen Sebelius received the petition that SRS sent to her—and simultaneously hand delivered to the HIT Policy Committee—Secretary Sebelius asked Dr. Blumenthal to respond to me. As head of the Office of the National Coordinator for Health Information Technology, Dr. Blumenthal chairs the HIT Policy Committee and, together with Secretary Sebelius, will accept or modify the recommendations on “meaningful use” and EHR certification that come from that committee and from CMS (Centers for Medicare & Medicaid Services). In the interest of continuing this conversation, I am extending the following invitation to Secretary Sebelius, as I already have to Dr. Blumenthal:
Dear Secretary Sebelius:
I received Dr. Blumenthal’s letter and was glad to hear that you appreciate the input provided in the Voice of the Physician Petition. The ability of the EHR incentives to successfully encourage widespread adoption of EHRs is inextricably linked to the belief by physicians that EHR technology is of benefit to them, as well as to all the other stakeholders in the healthcare delivery system.
I would like to arrange a brief meeting with you to discuss these very important issues in person. As the CEO of SRS, with 12 years of experience listening to and working with front-line physicians, I can offer you some valuable insights into what community-based physicians are looking for and how they perceive the legislation—likely a different perspective than that being presented by committee members.
SRSsoft was recently named to the Inc. 5000 list of most rapidly growing companies, and was identified as one of the top 100 healthcare companies. Our success and growth is directly attributable to the fact that our EMR development is driven entirely by the needs of private-practice physicians.
As the representative of thousands of physicians who want their voices heard—SRS clients and non-clients alike—I would be happy to come to Washington to talk with you. I am confident that you would find the conversation valuable.