In response to Jennifer’s post on Raising EMR in the Meaningful Use era, the always colorful Al Borges, MD provided the following comment:
Ahhh- but John, you’ve never compared EHR/MU to Death! The current Federal Government involvement in HIT is to providers more like the 5 steps of death and dying:
1) Denial and isolation: “This is not happening to me.”
2) Anger: “How dare Obama do this to me! What a jerk!”
3) Bargaining: “Please Obama- just let me continue to survive under Medicare.”
4) Depression: “I can’t bear to face going through this, I’m meaningfully depressed.”
5) Acceptance: “I’m ready to empty my pockets, go into debt, and possibly buy an expensive EHR or just retire… I don’t know. All I know is that I don’t want to struggle anymore.”
I, for example, am perpetually stuck in step 2. I continue to buck the system whenever I can. I’ve actually quit doing hematology/oncology and streamlined my [now] internal medicine practice to survive in these tumulous waters. Result: as more than 60% of the offices next to Virginia Hospital Center [my admitting hospital] have closed and been bought out by the hospital, I’m part of the less-than-40% that have survived. My income for 2011 will most likely show a doubling of my personal gross income.
As I’ve become a “nonpar” Medicare provider, I initially lost many Medicare patients, but I’ve gained what I want now- cash paying and younger PPO/HMO patients to fill in the empty slots. Many Medicare patients now have come back too, because I give them attention and the best care that I can offer. They pay me up-front using the “nonpar” Medicare contractual scale. THEY end up paying the current (s.a. eRx) and future penalties that Medicare will shell out, which is what always happens when big government taxes businesses- the clients end up paying the bill.
Some go through to step 5, buy an EHR, then either deinstall their systems, become hospitalists (or go to another endeavor), or retire. I plan on NOT going through these routes, at least for the next 10 years.
What needs to occur is that the Federal Government has out of HIT. Until that happens, we will never achieve a true “meaningful use” of EHR systems. Yes, doctors will get into inexpensive EMRs (like I have), but they will never buy into something that they cannot afford in both time and money. If EHR/MU continues, you’ll see Medicare suffer as doctors opt out or become “nonpar” making it difficult for the elderly to get the care that they need.
I know that Dr. Borges isn’t the only doctor that has done what he’s done. He’s much more outspoken about it than most, but every doctor I’ve ever met has had essentially the same feeling about Medicare: They hate it. Those that only modestly hate it do so because they realize that currently their livelihood depends on it. Although, even those wish they had a way to get out from Medicare.
While Dr. Borges story is interesting, his last question is the one that I think should be most concerning. Will the EHR incentive money and meaningful use drive many doctors to abandon Medicare and put Medicare in a bad position? One thing I believe goes against this trend is the number of hospital owned practices. I haven’t dug into the economics of hospital owned practices, but I’m pretty sure they won’t have the same flexibility to leave Medicare. I’d love to hear if you think otherwise.
Is Dr. Borges in the minority or could EMR and MU become a real issue for Medicare?