Revving the IT train

Efforts to create a "buyer's guide" for electronic medical records and loosening of Stark rules may not be enough to get physicians completely on board.

Posted Sept. 4, 2006.

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For years, the AMA and others in medicine have asked for help in getting doctors aboard the information technology train that shows so much promise to raise the overall quality and safety of health care. It's a train having trouble getting on track, in part because physicians are given little incentive, compared with others in the health care system, to hop aboard.

Fortunately, this summer physicians got some assistance -- namely, a buyers' guide of sorts and a loosening of Stark self-referral and anti-kickback rules -- that could help more of them jump on the infotech train. But it's only a start. More needs to be done to ensure that all physicians have the assurance they need to move forward.

The AMA shares "the widespread optimism over the promise that [health information technology] holds for transforming care." The Association stated so in a July 19 letter to Rep. John Boehner (R, Ohio), the House Majority Leader. But that optimism holds only if such technology is "properly developed and carefully integrated into the health care delivery system," wrote AMA Executive Vice President and CEO Michael D. Maves, MD, MBA.

The systems being developed are pricey and come with no guarantees that they are interoperable with other systems, or that they satisfy doctors' needs for privacy and security. Getting the wrong system is an expensive mistake. According to the journal Health Affairs, systems run $44,000 per full-time equivalent physician or other health care professional for initial costs, and $8,500 per FTE for ongoing costs.

Some progress has been made to assure physicians -- before they buy -- that there are systems that can meet their needs.

The Certification Commission for Healthcare Information Technology, which received a three-year, $2.7 million contract from the Centers for Medicare & Medicaid Services on July 18, released its first list of vendors and products that meet minimum criteria for ambulatory electronic medical record functionality, security and interoperability.

Even a product on the CCHIT list might not be worth it from a bottom-line perspective. In his letter to Boehner, Dr. Maves writes that physicians are expected to pay the full cost for systems yet receive only 11% of any return on investment. (No wonder only about 20% of practices have adopted EMRs.)

Dr. Maves' letter was in the context of a bill that already has passed the House (a version has passed the Senate but needs to be reconciled with the House bill). Among other things, it would codify the safe harbors to the Stark self-referral and anti-kickback rules involving health technology.

On Aug. 8 CMS said hospitals and other health entities could pay for up to 85% of the software and training costs for a physician practice's health IT software, as long they did not try to make that system incompatible with outside systems, or require referrals in return for the financing. The agency's ruling -- which is set to expire in 2013 -- clears up what was a murky question regarding outside assistance for physicians when it comes to paying for health IT.

It's good to see that CMS has recognized that others who benefit from physicians' use of such systems might now share their costs. But it's less encouraging that CMS still requires physicians to pay at least 15% of the cost -- a portion a hospital or other health entity is not allowed to finance. Given the limited financial and technological resources of many practices, 15% of that $44,000-per-physician initial cost is still not a bargain. Also, the AMA said it is concerned that the safe harbors are scheduled to end in seven years. After all, technology requires constant upgrades, maintenance and eventual replacement, so seven years really isn't all that much time.

Still, the CCHIT efforts and the Stark changes are a step in the right direction for removing barriers to physician entry on the IT train. If Stark rules can be loosened further, if tax credits and other incentives are given to physicians to encourage IT investments, if private and public efforts to set security and privacy standards reach fruition -- then you might really see that IT train start rolling.

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