Neither Stimulus Nor Penalties Seem to Motivate Physicians To Go Paperless

In my daily interactions with physicians and their staff members, I often have the opportunity to discuss the benefits of an electronic medical record system with in their practices. With all the information recently about the ARRA funds available, I have been approaching these conversations with the stimulus money as the carrot, much as the federal government has been doing for the past year. I almost never bring the threat of penalties into the conversation, because I do not believe that CMS will actually implement the penalties, but that is yet to be seen.  And to be honest I do not think that the Stimulus funds are a great motivator for adoption of an EMR,  and as such, neither are the potential penalties. 

The Physicians’ Reciprocal Insurers (PRI) recently posted the results of a survey they did of 500 physicians regarding Electronic Medical Records (EMR) software and the EMR stimulus money and penalties. Here’s one of their most interesting findings about EMR implementation:

One significant finding was awareness of financial incentives and penalties for implementing EMR systems.
While 85 percent of physicians were aware of the financial incentives for implementing the systems, more than 35 percent did not know that they face government-assessed financial penalties for not complying. The penalties are equal to a one percent reduction of the physician’s annual Medicare payments per year up to five percent.
However, those penalties do not seem to be having the intended effect, as more than 65 percent of physicians who were unaware of the financial penalties said this would not cause them to implement EMR.

So the question should be; “What is the actual benefit of moving to an electronic medical record system, versus that old, comfortable and currently utilized paper system of medical record keep?”

The financial benefit should be:

  • Increased office productivity (for example – no need to look for a chart with universal access to records)
  • Substantial  savings in office supplies of the actual medical record
     (i.e. file folder, coding labels, and dividers)
  • Elimination of printing charges for prescription pads, super bills, etc.
  • Elimination of storage cost of physical medical records
  • Substantial cost saving in fax paper, toner, and service contracts.
  • Automatic capture of charge codes
  • The ability to see patients faster, there is debate about this, but it is typically true for many EMRs and always true for a physician using ZipChart.  (Allows for either more patients per day or for the provider to have shorter work days, whichever is the desired outcome.
  • Help reduce hefty malpractice settlements and insurance premiums. A study conducted by Harvard researchers, found that 6.1% of physicians with electronic medical records has malpractice settlements, compared to 10.8% without an EMR

 The clinical benefit should be:

  • Increased patient care through better office communication
  • Safer prescribing through access to patient’s pharmaceutical history, allergies, and drug contraindications
  • Patient medical problem list, personal, surgical, family and social histories in an easy to read readily available location.
  • Test results, lab reports, surgery reports and imaging reports filed in the patient’s charts with copies sent to the physician for approval (this benefit fits in to both categories since  this should be completed with no staff time involved)

The ARRA HITECH Stimulus funds average out to $176 per week per provider (Medicare, Medicaid is more) over a period of 5 years.  However that is just the tip of the iceberg. The real money to be made with an EMR is in the cost savings and increased productivity of any medical office.

The bottom line is a physician should not be motivated to get an EMR by the ARRA HITECH stimulus funds, there is far more money to be saved/made in the implantation of an EMR, and there are the increased clinical documentation as well. It really is a win-win situation with an EMR, as long as it is the right EMR.  But, more about that next time.