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Digital Dilemma: Physicians oppose EHR requirements

by Geri Aston •

The federal government’s proposed rule establishing incentive payments for physicians who “meaningfully use” electronic health records (EHRs) is too onerous and would discourage physicians from participating, some otolaryngologists say.

“The idea of having physician’s offices and medicine brought into the electronic age is very noble and worthy,” said Howard Kotler, MD, clinical assistant professor of otolaryngology/head and neck surgery at the University of Illinois College of Medicine in Chicago. He added, however, that the proposed rule would “make it impossible to get the payments. It will further alienate physicians from the government and vice versa. And it will do nothing to improve quality of care, and that’s the key thing.”

“Meaningful Use” Defined

The rule includes 25 meaningful use criteria for physicians to report in order to qualify for incentive payments, which are available starting in 2011. Beginning in 2015, physicians who do not meet the meaningful use criteria will not receive full payment for their Medicare professional services.

The number of criteria is too high, the thresholds established to meet them are often too tough and the timeframe to get payment in the first year is too short, otolaryngologists interviewed by ENT Today said. The American Medical Association (AMA) agreed with this assessment in its March 15 letter to the Centers for Medicare & Medicaid Services (CMS). The proposed meaningful use criteria are “too aggressive” and, if adopted, would deter many physicians from participating in the incentive program, the letter states.

The proposed regulation, which would implement part of the American Recovery and Reinvestment Act of 2009, would require physicians to provide patients with clinical summaries of their office visits. To meet the measure, doctors would have to provide these summaries for at least 80 percent of all office visits.

“That sounds fantastic, but how about operationalizing it?” said Rahul Shah, MD, FACS, FAAP, assistant professor of otolaryngology and pediatrics at the George Washington University School of Medicine and Health Sciences and attending physician in the department of otolaryngology at Children’s National Medical Center in Washington, D.C. The 80 percent threshold and other targets seem pulled out of thin air, he said: “It feels like we’re being set up to fail on something that sounds attractive to the average consumer.”

The AMA letter notes that it might not be practical or necessary for physicians to give every patient a summary at the end of each visit. According to the association, doctors and patients are in the best position to decide what records are needed and when.

How Much Will You Get?

The size of your incentive payment will vary depending on whether you participate in the Medicare or Medicaid arm of the program, whether you are in a health professional shortage area (HPSA) and what year you begin participation. Here is the maximum possible amount over the entire course of the incentive program, listed by the first year of incentive payment.