Independent medical practices facing squeeze of electronic records requirements
When Patricia Edwards sees her young patients for their annual checkups, she asks how the school play went the previous spring, or how soccer camp was last summer.
She’s not endowed with a super-human memory for detail. Just an old-fashioned paper chart, with a regular habit of making notes in the margins about things that are important to her patients but that don’t fit neatly into the forms of their medical records.
Edwards is hearing from some younger doctors that they’re finding it harder and harder to connect with patients, and she wonders if their lack of margin notes couldn’t be one reason.
Why no notes in the margins for those other doctors? Their offices have switched to electronic records, so there’s no paper margin to make notes in.
“Patients pick up on this, and for doctors, you’re losing the narrative of medicine. There’s no nuance. It’s, ‘Are you doing well in school? Click. Are you playing sports? Click,’ ” said Edwards, president of Concord Pediatrics.
Whether or not to go digital is a “constant conversation” for her and her partners, Edwards said, but for now the decision is still no.
They have the ability to stay offline because the office doesn’t rely on Medicare for funding.
Other providers are finding they are stuck between adapting or losing significant portions of their revenue in the near future.
The federal stimulus bill passed in 2008 contained billions of dollars in funding for medical providers to adopt electronic health records. Hospitals jumped at the chance to use the incentives to pay for expensive electronic programs they were planning anyway.
The incentive payments are disbursed based on how many of a practice’s patients are covered by Medicaid and Medicare.
To hold providers accountable for how they used the incentive funds, the government outlined a list of standards called “meaningful use” for electronic records. All providers will have to meet meaningful use eventually, or they’ll face deductions from their Medicare payments.
Hospitals in particular faced steep penalties if they didn’t eventually comply with the standards, which are designed to increase patient safety and engagement in their medical care.
For some smaller providers, such as independent doctors’ offices like Edwards’s, the incentives haven’t been big enough to justify the costs of meeting the high standards; after all, the threat of Medicare penalties isn’t very ominous to a pediatrician.
However, for New Hampshire Oncology-Hematology, which has offices in Concord, Hooksett, Laconia and Londonderry, the looming penalties were compelling, said Peter Crow, a physician partner at the practice.
The practice has paid close to $1 million over the past five years for an initial electronic records installation, plus hardware, training, monthly software updates and maintenance, he said.
The move to electronic records was controversial, and was decided after much debate among the physician partners.
“For those who were against it, and I understand where they were coming from, they said, basically, it’s stupid and it has nothing to do with quality,” Crow said.
“I argued, if we want to keep doing the things in our practice that are important and are related to quality, we have to get money where we can. . . . There have been incentives, and it’s been good to recoup some of that money, but certainly not all of it,” he said.
Concord Women’s Care, a two-physician obstetrics and gynecological practice, adopted a cloud-based record system four years ago, partner Ashish Chaudhari said.
“Ultimately, the reason to switch was we could see the writing on the wall that technology was changing at a rapid pace and the government was going to require us to change eventually,” he said.
Like Edwards, his practice likely won’t face much threat from the Medicare penalties awaiting providers that don’t comply. But his practice wanted to take advantage of the incentive dollars.
Even with the funding, “the cost is substantial,” he said.
“There were three to six months of learning the system. . . . So there was a loss of income from seeing fewer patients, and staying later to learn the system, and paying out for the hardware and software. For at least a year, it was a solid hit,” he said.
Meaningful use was designed to achieve several goals. By having electronic records, patients could access their own health information and make more informed choices, and doctors could coordinate care across multiple health settings. Electronic records, like bar codes on prescriptions that have to match codes for the patient receiving the drug, for example, are also less open to human error.
Even while they agree electronic records can provide benefits, some doctors still say the standards can be cumbersome, time-consuming and annoying.
If a woman came to Chaudhari’s office with a minor gynecological complaint and then returned a week later for a follow-up visit, he wouldn’t have taken her blood pressure and pulse again for the paper system.
Now, the record of every visit has to contain up-to-date vital signs.
Physicians also have to mark in the record if a patient smokes, and then ask at every subsequent visit if the patient has quit or considered quitting.
“When we’re treating patients with terminal lung cancer, it really doesn’t matter if they quit smoking,” Crow said.
His practice has set up the system so the basic health questions and evaluations are handled by assistants, not the oncologists, he said.
“If it’s not part of their job and it’s not something they value, the doctor isn’t actually going to be that good at doing it,” he said. “Ideally, you’d want us to be focused on the patient with lung cancer, not on a screen.”
(Sarah Palermo can be reached at 369-3322 or firstname.lastname@example.org or on Twitter @SPalermoNews.)