Is IT ready to pay for itself? (HIMSS meeting)

If you had to shell out $20,000 to $50,000 per physician for start-up costs and endure six months of operational hiccups in hopes of boosting your income 1%, would you buy an electronic medical record?

That's the question most health plans, corporations and others adopting pay-for-performance programs are asking, in hopes of encouraging physicians to use EMRs.

Some pay-for-performance programs directly reward physicians for buying EMRs, while most ask physicians to provide information that's much easier to capture and organize electronically.

At several sessions held during February's Annual Healthcare Information and Management Systems Society Conference & Exhibition, there was widespread recognition among industry professionals that 1% probably isn't enough of a pay-for-performance bonus to convince physicians EMRs can pay for themselves. HIMSS is a Chicago-based industry group that produces the largest health care information technology conference in the country, luring more than 25,000 people and more than 860 health care technology companies touting their products at the San Diego Convention Center.

But while many at HIMSS thought the current incentives probably aren't enough, there was no consensus on what will get physicians to act.

Physicians "need more money because that's the only way they are going to be able to adopt systems and processes that are going to transform the way they can manage care," said Francois de Brantes, program leader for health care initiatives at General Electric Co., a Fairfield, Conn.-based conglomerate that is a key player in the Bridges to Excellence pay-for-performance program run by a consortium of large corporations.

Based on the experience of Bridges to Excellence, it will take bonuses amounting to 5% to 10% of a physician's annual income to promote wide adoption of EMRs, de Brantes said. "We noticed that physicians at individual practices need to be at the higher scale. Physicians that participate in large groups can be at that lower scale."

Others, however, have proposed a much lower incentive bar. In 2005, Congress considered but failed to pass several bills authorizing the Centers for Medicare & Medicaid Services to offer pay-for-performance bonuses of 1% to 2% to physicians and hospitals, said Christine Bechtel, director of government affairs at the American Health Quality Assn., during a session at the symposium.

A "meaningful" incentive for Louis Civitarese, DO, a family physician at 35-doctor Preferred Primary Care Physicians in Pittsburgh, would be approximately $25,000 per physician. That is about what his group paid to implement its EMR two years ago.

Dr. Civitarese, however, recognizes it would be cost prohibitive for health plans or employers to cover the start-up costs of every group in the country, especially since smaller practices would see substantially higher per-physician costs. He'd settle for incentives that would cover the group's EMR maintenance, which is about $11,000 annually per physician. "I don't think pay-for-performance has to pay for the whole thing. But it has to pay for part of it."

Several groups in the Pittsburgh region have visited his group to check out its EMR. Without fail, their first question is whether Preferred Primary Care has recouped its investment after two years. His answer: Not yet.

"It takes the wind out of their sails," Dr. Civitarese said. "I think if physicians saw a realistic plan with regards to pay-for-performance to even allow them to recoup their investment and ongoing maintenance costs, then I think they would be much more willing to jump in."

It's been four years with an EMR for Prairie Cardiovascular Consultants Ltd., of Springfield, Ill., and the 44-doctor cardiology group still hasn't recouped its money.

"We see pay-for-performance as an opportunity to at least get some return on investment for the cost, efforts and sacrifices that we made to try to improve quality," said Frank L. Mikell, MD, practice president.

To prepare to participate in pay-for-performance initiatives, Dr. Mikell's group is implementing an internal program to reward doctors who achieve certain measures on quality, adherence to information technology and patient satisfaction.

The group's partners have agreed to set aside 5% to 10% of their income into a pool, to be awarded physicians who meet the performance criteria. The group independently concluded a few years ago that the incentive had to be this high "because otherwise people wouldn't be motivated to do it," he said.

Whatever the size of the pay-for-performance bonus, the bottom line is that physicians must first know the concrete financial benefits as well as the costs for improving performance, AHQA's Bechtel said during her session. "It's got to pass the smell test for each practice."