Managed Care - October 2008 - (Page 6) LEGISLATION & REGULATION Citing a shift by the Permanente Medical Group, the California HealthCare Foundation reported early this year that use of electronic health records in the state had risen to 37 percent of physicians. Yet even in California, 59 percent of physicians — primarily in smaller groups — say they still can’t afford a system of their own. Forty-two percent said they were leery of the cost of just maintaining a system. “My own gut instinct is that as we get more widespread adoption without really good technical support, we’re going to have a lot of failures,” says DesRoches. “You need a lot of help to get it up to speed. In the absence of good technological support, I think we’ll see some abandonment of these systems.” Some scary numbers Mark Anderson, CEO of the AC Group, an IT consulting firm, put the tab for a certified EHR system at $35,000 to $50,000 per doctor over three years — a daunting figure for the nearly two thirds of the doctors in the NEJM survey who pinpointed the cost as their biggest hurdle. But the problem, Anderson insists, isn’t really the cost of the hardware and software. He places the blame primarily on old systems in use that don’t meet CCHIT certification requirements as well as many that do meet the standards but aren’t being fully implemented. “Our clients tell us it requires way too much change in the way physicians practice medicine today,” says the IT expert. “It slows them down, requiring them to enter a lot of information they never entered before. The average physician spends two minutes documenting a new patient and 38 seconds documenting a return patient because they dictate relatively quickly. “Every patient is brand new when you go to an EMR, but in the average physician practice Sugggest a topic Is there an emerging health care topic in the area of federal or state legislation or regulation that you feel would be of interest to readers of MANAGED CARE? Write to John_Carroll@managedcaremag.com only 10 percent are actually new. Ninety percent are return. They go from a quick 38 seconds for the paper system to 4 to 5 minutes to document everything on the EMR, 50 patients a day.” The problem is that vendors put the responsibility for entering the data on physicians. But if you get a combination of nurses and physician assistants as well as the patients doing the job, full adoption rates should rise. Add higher payments and bonuses for doctors who switch to a system that rewards physicians for keeping patients healthy rather than just treating them while sick and the country can make significant progress — or so the advocates of EMR systems say. “If we don’t change the way we do things, we’ll get to 20 percent of doctors using the full EMR by 2014, moving from 4 percent,” says Anderson. “We could be at 80 percent by 2014, but we have to get back to reality. The vendors never discuss cost of data entry because they assume there is no cost.” There’s no question that major obstacles remain, says Karen M. Bell, MD, director of the National Coordinator’s office of Health IT adoption, particularly for small physician practices. This is a profession where a 40-hour work week is practically unheard of, she notes, and asking a group of hard-pressed professionals to change the way they practice medicine is no easy task. But payers of all stripes need to play a role here, she adds, including MCOs. Managed care companies stand to benefit financially from the increased efficiency promised by these new systems, she notes, and they need to find ways to share that money with the physicians who are being asked to tackle the challenge. “If Congress authorizes CMS to pay more to physicians, then we could see a good jump up,” says DesRoches. And she agrees that managed care has a role to play here as insurers roll out some pilot programs of their own. This is one initiative that needs plenty of money to fuel adoption. “At the current rate, we are clearly not going to get there,” says DesRoches about the Bush administration’s technology goal. MC 6 MANAGED CARE / OCTOBER 2008
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