AMA House of Delegates

Steven Kaning, MD, (left) joined physicians making their voices heard. His wife, Barbara McAneny, MD, also was a delegate.

AMA meeting: Doctors object to penalties for avoiding EHRs

■ Delegates call for eliminating Medicare penalties for failing to show "meaningful use" of electronic records by 2015. But some fear incentives could also go.

By Emily Berry — Posted June 29, 2009

Chicago -- Physician-delegates at the AMA Annual Meeting in June formally came out against planned penalties included in this year's federal stimulus bill that would dock Medicare pay for physicians who do not have a qualifying electronic health record.

The "adjustments" start at 1% of the physician's Medicare fee schedule and are set to begin in 2015, after four years of available incentives for adoption. The penalties are set to increase each subsequent year to a maximum of 5%.

Delegates passed a resolution calling for the Association to ask the federal government to eliminate the penalties and advocate for federal assistance with up-front and maintenance costs of EHR use.

The stimulus package, officially titled the American Recovery and Reinvestment Act of 2009, sets out incentives for both physicians and hospitals who can demonstrate "meaningful use" of an EHR, including the use of an e-prescribing component. Qualifying physicians will be eligible for additional Medicare payments of as much as $44,000 over the course of five years, beginning in 2011.

The national Health IT Policy Committee, an advisory group charged with defining principles for "meaningful use," released its first draft recommendations June 16, but the Centers for Medicare & Medicaid Services has indicated proposed rules won't be released until late 2009.

There is a case-by-case exemption written into the law for physicians who can demonstrate "significant hardship, such as in the case of an eligible professional who practices in a rural area without sufficient Internet access."

Delegates at the Annual Meeting argued that the penalties violate the AMA's pay-for-performance policies and unfairly punish physicians who can't afford the up-front cost of adopting an electronic record system.

"My financial calculations say it's cheaper for me to take the penalty than to put the system in, and that's what I'm going to do," said David McKalip, MD, a neurosurgeon and alternate delegate for the Florida Medical Assn.

No coverage for up-front costs

There are no provisions in the stimulus package that cover the up-front cost of adopting an EHR for a physician in private practice, and some physicians are concerned about buying an EHR now without knowing exactly what type of system will qualify them for incentives.

"Whatever you're buying now is going to be obsolete in the near future," said Stephen Sebert, MD, a family physician and president of the West Virginia State Medical Assn.

Other physicians speaking to the issue in reference committee urged delegates to "not throw the baby out with the bathwater" and pointed out the incentives represent the first assistance the government has offered for health IT adoption.

"I think if we ask for this to be rescinded, what we'll wind up with, possibly, is nothing," said Steven Kanig, MD, a nephrologist and delegate for the New Mexico Medical Society.

ADDITIONAL INFORMATION

Meeting notes: Medical practice

Issue: Guidance and policy is needed on the use and release of physician data.
Proposed action: A Board of Trustees report provides physicians guidance on the release and use of their data, including patient privacy safeguards, data accuracy and security safeguards, transparency requirements, review and appeal requirements, physician profiling requirements, quality measurement requirements and patient satisfaction measurement requirements. [Adopted]

Issue: Solutions are needed to address overcrowding in hospital emergency departments.
Proposed action: A Council on Medical Service report congratulates the American College of Emergency Physicians for developing solutions to the problem of overcrowded emergency departments. The report also supports collaboration between organized medicine and ED staff, and the dissemination of best practices, in efforts to reduce ED boarding and crowding. [Adopted]

Issue: Certain specialists are required to be in-house on a 24-hour basis at some hospitals. Some are not paid for this in-house coverage while others are.
Proposed action: The AMA work with the American Hospital Assn. to require the equitable treatment of all specialists required to provide in-house coverage. [Adopted]

Issue: The growth of the hospitalist movement has resulted in less hospital volume for some physicians. This has made it difficult for low-volume physicians to demonstrate clinical competencies in a hospital setting, as required by some credentialing rules.
Proposed action: The AMA adopt guidelines to assist medical staffs with credentialing and privileging physicians with low activity. [Adopted]

Issue: As employees of physicians, allied staff, including nurse practitioners and physician assistants, have little contact with the activities of organized medical staff, especially concerning patient care, safety, quality and ethical issues.
Proposed action: The AMA study how hospital medical staffs can involve allied staff in oversight activities. [Adopted]

Issue: Radiology benefit managers interfere with patient care and place an unnecessary burden on physicians and compromise patients' health by substituting tests or denying approval for tests.
Proposed action: Oppose routine denials or substitutions by RBMs working for third-party payers, study the prevalence of forced substitution of one study over the one requested, support the use of appropriate-use criteria developed by physicians with expertise in the specialty that pertains to the patient's condition. [Adopted]

Issue: Electronic medical records place the purchaser at the mercy of a vendor when the system needs fixing or upgrading. Open-source coding allows users to make changes and update as necessary.
Proposed action: Ask the AMA to develop open-source EMRs that meet "meaningful use" criteria, and make them available at a nominal cost to physicians. [Adopted]