EMRs, quality efforts key to viability of practices, Obama officials advise

Washington -- Physicians who fail to tackle quality improvement, adopt electronic medical records and embrace teamwork risk being at a competitive disadvantage with doctors who join the modern era of health care, federal officials warned physicians at the AMA National Advocacy Conference in Washington, D.C.

CMS Administrator Donald M. Berwick, MD, told physicians in his Feb. 9 keynote speech at the annual conference that the national health system reform law is encouraging doctors and hospitals to embrace quality improvement the way other businesses already have. He acknowledged that the law is contentious.

"But let me tell you it's good. It's what we need as a step forward to help us in this new world of care," Dr. Berwick said.

Physicians cannot continue to practice the way they did a few decades ago, he said. The world no longer allows a physician to practice in isolation and serve as the local authority on health care, as Dr. Berwick said his father did as one of two general practitioners in a central Connecticut town of 5,000 in the 1940s.

"He would need help to digest knowledge today that he didn't need before," Dr. Berwick said, citing the vast number of clinical trials. Also, patients often arrive in offices having conducted extensive research on their conditions.

Too many people enter the health care system and are unintentionally injured, said Dr. Berwick, a pediatrician. He recounted how the mother of one of his patients called one night to report that her son was having a seizure because he had taken a prescription five times as strong as the dose Dr. Berwick prescribed.

"To this day I don't know how it happened," he said. "I think I wrote it correctly. I think the pharmacist was good. But somewhere along this chain, the kid got hurt when I was trying to help him."

Physicians may not have caused all of these accidents, Dr. Berwick said, but they need to help come up with better systems to prevent them. He said physicians already have the knowledge they need to do that.

Improving quality is the key to putting the U.S. health system on firm financial ground, Dr. Berwick said. "Physicians who will help us create the new system, not guard the old one ... will have the best answers to sustainability."

Adopting health information technology is another area where doctors need to act, officials said. Some physicians' reluctance to adopt EMRs is understandable, especially those close to retirement, said David Blumenthal, MD, the outgoing national health information technology chief, in his Feb. 10 address at the conference.

But the $27 billion Congress authorized for EMR adoption bonuses is a one-time opportunity, he said. "They will never get help from the federal government again."

Physicians who fail to invest in EMRs will see their practices decline in value relative to colleagues who do invest, Dr. Blumenthal said. They also will face more difficulty recruiting young physicians and attracting patients who will expect such technology, he said.

Pressure on physicians

During questions after his address, Dr. Berwick was asked how physicians can be expected to help achieve such quality improvements when they handle patients who want more care than they need and make it clear that they will take whatever steps necessary to obtain it. The CMS chief responded that doctors should be mindful of what patients truly need but also make an effort to understand what is motivating their demands.

Chip Kahn, president and CEO of the Federation of American Hospitals, questioned the notion that reducing health spending is key to making the health system more sustainable. Amid declining revenues, physicians and hospitals can only reduce their expenses so much, he said.

"At the end of the day, it means something bad is going to happen. It ain't going to help your bottom line," said Kahn, speaking Feb. 9 at the AMA conference. America has great health care, but it might become unaffordable, he said.

Payment methods should reward physicians and hospitals for keeping patients healthy, said Harold Miller, executive director at the nonprofit Center for Healthcare Quality and Payment Reform. "Nobody gets paid at all when patients stay well."

Such payments could be possible under accountable care organizations, as mandated by the health reform law. At this article's deadline, CMS was preparing to unveil a proposed rule on ACOs, which will allow physicians and hospitals to work together on coordinating care and sharing some of the savings that they generate for federal health programs.

But Miller said the public could turn against ACOs if people feel they are another way to ration care. Kahn questioned how ACOs will effectively coordinate care for patients who don't stay in the care network.

Reducing the bureaucracy

Physicians attending the AMA's advocacy conference also were invited to identify federal regulations and policies that could be improved or rescinded. On Jan. 18, President Obama issued an executive order to all federal agencies asking them to analyze rules that may be "ineffective, insufficient or excessively burdensome."

The AMA encouraged physicians to submit their own suggestions through an Association survey available online. "The results of this survey will help the AMA identify which federal rules and regulations create the most burden for physicians without providing positive benefits for patients," said AMA President Cecil B. Wilson, MD.

Jonathan Blum, deputy CMS administrator and director of the Center for Medicare, also took regulatory relief suggestions from physicians at the conference on Feb. 9. He said the move to dial back regulations comes every so often. "Our challenge this time is to make it meaningful and make it real."

Physicians raised a variety of regulatory issues they have with CMS, including Medicare pay cuts the Obama administration imposed on cardiologists in 2010. The cuts of up to 40% have forced many independent cardiologists to work for hospitals, which are paid higher rates, said C. Richard Schott, MD, a cardiologist from Wallingford, Pa.

"If this is not fixed, we're all going to end up being hospital employees," he said. "It's killing us."

Blum said CMS takes the issue very seriously and is monitoring the utilization of cardiology services.

Corey Howard, MD, an internist in Naples, Fla., said the new Medicare wellness checkup in the health reform law doesn't cover much beyond a conversation with physicians. "It's not much more than a checklist." Blum said he would look into it.

Blum also said he would investigate several other issues raised by physicians at the forum. They include the amount of physician signatures and documentation CMS requires for payment.

At the end of the three-day conference, physician attendees visited lawmakers on Capitol Hill to push for Medicare payment reforms and other legislative priorities.