Healthcare Reform: Get Ready for the Crush!

Against what seemed to be insurmountable odds, President Obama has signed a healthcare reform bill. While the full impact of the bill won’t be known for a while, two things are already clear about this legislation’s effect on physicians. There will be a sharp increase in demand for their services, and they will get paid less for the services they provide—making physician productivity vital.

By 2014, all Americans will be required to have health insurance. A whopping 32 million people will be added to the rolls of private health insurance plans over the next few years with the help of government premium subsidies. Because these people have not had health insurance in the past and many have medical problems for which they have not received treatment, they can be expected to seek care in greater-than-average numbers. Compounding this demand will be the seismic shift in demographics caused by the aging of the 79 million baby boomers, the first of whom turn 65 next year. Their naturally increasing demands for medical care will further stress our healthcare delivery system. Given the current, and growing, physician shortage, physicians will be deluged with patients.

With a projected cost of $938 billion, much of the funding for the legislation will come from cuts to Medicare, which will include payment reform—a euphemism for reduced payments for the services provided by physicians.

Physician productivity has always been important, but the healthcare reform legislation has made it critical. To meet the crush of demand for care, and to grow—or even maintain—their current incomes, physicians will have to see a greater number of patients and do so more efficiently. Now—more than ever—it is important for physicians to invest in software that is physician focused and designed with physicians’ workflows in mind, to ensure that it will increase, rather than decrease, their productivity.

Reminder: to find out what your time is worth, try the physician productivity calculator.

Lost Opportunity: EMR Reform Was within Our Grasp

In October of 2007, the government (or specifically, CMS—the Centers for Medicare and Medicaid Services) had a great idea: It announced a 5-year EHR demonstration project. The project had goals similar to the EMR Reform concept detailed in last week’s EMR Straight Talk. The government set about to scientifically investigate whether “investing time and money to convert . . . to EHR is worthwhile [for physicians] or not.” The project would also specifically measure physician satisfaction, exploring how EHRs affect workflow and identifying which functions physicians actually use. The goal was to “examine practices’ experience in implementing and using EHRs” and to evaluate “providers’ perceptions of the effects on their practice and patients.” This was a great start at a sorely needed objective evaluation of the efficacy of EMR in physician offices.

Why did the government fund this program to the tune of $150 million? My guess is that it was because they recognized that no study existed to support the commonly held—but undocumented—assumptions regarding the value of EMRs to physicians. The few landmark studies that have been conducted have focused on the value to other stakeholders—insurance companies, the government, etc.—but not to physicians.

The demonstration project had a start date of June 1, 2009, and will encompass 5 years of data collection. Yet on February 17, 2009, in a rush to push through legislation, and encouraged by special interest groups, President Obama signed the Stimulus Bill before the first demonstration test site was even operational. The government will now spend $36 billion supporting the very same EHRs they had wanted to study, but without the benefit of the potentially valuable information that the demonstration project could have provided. Nor will they have heard from physicians about what actually works in the real world of medical practice.

So here we are, embarking on a massive government program enticing physicians to invest in and implement software that the government itself has acknowledged is unproven in value—and urging physicians strongly that the time to do so is now—despite the fact that the demonstration project’s Phase I is just beginning and preliminary results will not be available until 2014.

Don’t we have a responsibility to provide physicians with at least the level of decision support to which they have access when they buy a car? Regrettably, this failure represents a lost opportunity to produce an EMR report card that would let physicians see what is really going on “under the hood”—before we expect them to invest their hard-earned money. Never before has the argument for EMR Reform been so compelling.

Make It Happen!

The message is clear—physicians are concerned that their interests are being ignored, and they want their voices heard.

SRS is making that happen. We hear the voice of the physician and we will be broadcasting it to President Obama, HHS Secretary Kathleen Sebelius, Dr. David Blumenthal, the HIT Policy Committee, the HIT Standards Committee, and leading industry blogs.

Following last week’s post, entitled “The Silent Majority is Being Heard – Let’s Be Louder,” we invited SRS clients and non-clients alike to let us represent their voices in Washington. The response from physicians and practice administrators has been tremendous—not only have we already received an unprecedented number of signatures to our letter to government officials, but we are being deluged with individual comments to be forwarded along with the letter…and they are still pouring in.

There is still time to join the campaign:

  • Sign our letter and/or add your own comments.
    Click below to read and then sign:

SRS Client Petition Non-Client Petition

  • Share this with your colleagues—physicians and practice administrators—and encourage them to let us speak for them.

Whether your practice is using SRS, has another EMR, or is still on paper charts, this is about you. Will you be able to meet the increasingly stringent “meaningful use” requirements currently under consideration by the government? The following are just a few of the voices that your peers have already asked us to share with Washington:

  • “We support efforts to reduce the cost of healthcare without reducing quality, and we recognize the value of a computer-based health record for quickly sharing patient information with other providers and avoiding duplication of services. However, the methodology for doing so should not be so burdensome as to change how a physician practices medicine, particularly if it interferes with patient-doctor interaction.”
  • “We have implemented an EMR system in our practice and are leaders in our area in implementation of new technology. However, despite numerous attempts, we have failed to find an EHR system for entering clinic notes and orders that improves efficiency. Instead we have found it only makes us more inefficient, less productive, and more frustrated. The right technology is not here yet. We cannot be forced to implement a flawed system.”
  • “I am a primary care doctor. Point-and-click does not work for us either. The vast array of problems that we handle requires a more flexible way to document a visit. We handle usually 3 different issues on average per visit. Point-and-click falls apart if there is more than one chief complaint or if the patient tells us something that has not been considered by the point-and-click software. The documentation is forced to become less accurate. There is also an impact on the relationship with the patient since the doctor spends more eye contact with computer rather than the patient. I am not a doctor who is afraid of technology. I have a degree from M.I.T. in electrical engineering and worked as an engineer for years before changing careers. If point-and-click EMRs were useful, my practice would have had it years ago. Electronic prescribing has benefits and we have been doing that for years. We have a hybrid system that we currently use and will add other features when it makes sense. I do not believe we will ever use a point-and-click system even with incentives.”

The AMA is expressing the same concerns that we have been voicing—they formally came out against the planned penalties in the federal stimulus plan at their annual meeting this month.

Please add your own voice now, and let us make sure that you are heard.