The Health Information Technology for Economic and Clinical Health Act’s (HITECH) major goal is to increase EHR adoption. The major questions are “Is it enough?” and “Will it work?” Let’s take a look at each of these questions.
Is it enough?
The Health Information Technology for Economic and Clinical Health Act (HITECH) provides $18 million in incentives through Medicare and Medicaid reimbursements. Starting in 2011, physicians who show that they are “meaningfully” using health IT would be eligible for $40,000 to $65,000, and hospitals would be eligible for several million dollars. The incentives would be phased out over time, with penalties in place by 2016.
$40,000 seems like a large chunk of money for EHR. Of course, we have to remember that it’s spread out over 5 years, but $40k isn’t insignificant. Sure, many EHR out there cost $200k plus to implement. However, not all of them are this expensive. In fact, I’d say that the EHR market has shifted from mostly high priced EHR to more moderately priced EHR with unique pricing structures.
The possible problem with the HITECH legislation is that we still don’t know how HHS will interpret what a certified EHR will be. If they say it’s a CCHIT certified EHR, then $40k might not be enough reimbursement. If they create a better standard for certification which will include specialty EHR and smaller but effective EHR software, then $40k is probably enough for many doctors to turn the corner and implement an EHR.
Will it work?
My simple answer is No.
Let me explain my reasoning. I think we all underestimate the biggest reason why most doctors don’t want to implement an EHR. Many doctors just don’t want to change. Sometimes this is related to fear (see colleagues failures). Sometimes it’s related to retirement pending. Most significant is they just don’t see how it benefits them (the doctor). Throwing a little cash at them isn’t going to change their desire not to change. They’ll just find another excuse. They’re preferred EHR isn’t “certified” might be a good one.
We also have to remember that this isn’t cash up front to pay for the EHR. It comes in the form of Medicare and Medicaid reimbursements that you hope you’ll qualify for after having spent money, time and energy (the oft forgotten element in an EHR implementation) implementing an EHR. If this was cash up front I might have a different point of view. However, far too many doctors have been screwed over (excuse the descriptive language) by Medicare and Medicaid reimbursement. Let’s not be surprised if many doctors don’t believe that they’ll ever see any of this extra Medicare and Medicaid reimbursement. If you still think this is far fetched, just do some research on doctors’ experience getting this same type of reimbursement from the ePrescribing initiative.
Add in the increased “paperwork” otherwise known as reporting requirements to receive the reimbursement and hopefully you’ll have an idea of why I think this won’t work. Most doctors want to see patients. They don’t want to deal with extra paperwork which includes researching an EHR. This is government aid were talking about and that’s pretty much synonymous with red tape.
I’m not trying to be a pessimist, but I am trying to be realistic. I just don’t see this new stimulus package having the desired effect on EHR adoption. More importantly, I hope that doctors take their time in selecting an EHR properly and aren’t swayed by the dollar signs EHR vendors will certainly be waving for them. Another set of poorly selected and implemented EHR will set back EHR adoption for years to come.
Luckily, I’m optimistic that most doctors have seen enough failures around them that they’ll tread lightly and not rush into EHR implementation.