Truthfully, when I opted out of Medicare (and seeing those patients) in July 2011, I kind of sealed my fate in not being able to go for the Meaningful Use EHR incentives.  I did however, as an experiment, try to attest to see how far I could get using data from the first six months of the year.  Let me just say that the chart reviews, mouse clicks and calculations got so involved that I was glad when I found out, after only reviewing the charts of 55 qualifying Medicare patients, that my numbers and percentages weren’t sufficient for qualifying for meaningful use.

Nevertheless, I forged ahead to the end of my “experiment”.  CMS’ EHR incentive portal is a funny and bass-ackwards system, in a way, because it lets you get to the painful end of the long data entry process without telling you, “Hey wait, stop now since you’ve already failed on this one measure (by percentage).”  Half of the time I was guessing at what I thought they wanted, being that the specific questions involved in attsting are so poorly worded that they leave a lot of roof for creative interpretation. How the people in charge at CMS figure that they will get accurate research data in such a context is beyond me, but then this is a typical government-run system – dysfunctional is par for the course.  You can honestly attest that your numbers are true “to the best of your knowledge” in the end because you didn’t really know what some questions were asking for.  Apparently, your best guess is okay.

Nope.  Rather than warning you of your demise early, they let you get to the bitter end and then they tell you in a summary page all the points along the way that you actually failed at in meeting the MU requirements.  I have to admit that they had me going there for a while.  I really was thinking, “Well, they let me get this far, so maybe I can just submit and report the measures and the government will honor all my hard work and time spent.  Maybe the goal for a partcular measure X is 50%, but they just want any numbers this time around, being that this is only Stage 1 of MU.”

I have heard stories of MU attesters/doctors who said they were so exhausted by the time they finally finished the process that I suspected, going in, this wasn’t going to be a cake walk.  However, in fairness, our EMR system had not yet put into action its “MU Dashboard” function during the first part of 2011, when I actually saw the patients.  The dashboard function/page now allows convenient tracking of all measures and calculates the numbers for you… after, of course, you go through the time-sucking process of checking off all the measures that are required to qualify.  And I only had around 70 Medicare patients.  Imagine those doctors with hundreds or…. gulp… thousands.  Just to give you a sample of the pain, last week I tried entering allergies for 20 random (non-Medicare) patients the next day after I saw them.  The dashboard function doesn’t do this for you, after all, and my patients’ allergies are recorded as free text (unstructured data) using my template system.  By the time all clicks were done, it took me 10 minutes of solid mouse clicking time at a brisk pace.  Pages have to load up, after all.  I could have done so much else with that 10 minutes of my life that I’ll never get back.  Talk about frustrating.

I did a crude calculation and took $44,000/(5 yr x 365 days/yr) and came up with $24/day for a heck of a lot of work.  In doctor-speak, it ain’t worth it.  Now I’m not poo-pooing the do-gooders out there who want to give their time to this process and try to make the world a better place through being meaningful users of health IT.  Just please don’t hate the business-oriented group of doctors out there who have done the math and dabbled in it enough to choose otherwise.

Dr. West is an endocrinologist in private practice in Washington, DC.  He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine and opened The Washington Endocrine Clinic, PLLC, as a solo practice in 2009.  He can be reached at doctorwestindc@gmail.com.  He blogs at HappyEMRDoctor.com and EHROutlook.com.

Today’s blog is a bit of a departure from my usual EMR and EHR focus, but I think that Medicare is pretty intricately intertwined with the EMR incentives via Meaningful Use, and so I thought I would share some perspective on a recent article that set my mind’s hamster wheel spinning.

Bob Keaveney’s article at Physicians Practice, With Friends Like These… paints a powerful summary to the reason doctors are running from Medicare and Medicaid — left and right — these days and how the New World Order coming in the form a ACOs may put a strain on the relationships between physicians and patients.

Last Tuesday evening, my practice manager was visiting with a freindly neighborhood PCP and her practice manager from down the road.  They are literally a block up as a matter of fact.  My manager was helping them understand how we use our EMR system, Practice Fusion, and how they could do the same.

The conversation at one point turned to why we were seeing a lot of Medicare patient referrals for diabetes care from the PCP’s father earlier this year.  Her father is also a PCP in the same practice here in DC.  She had an interesting answer.  “Oh, he left Medicare and had to find a home for them.  I’m also planning to leave Medicare in January 2012,” she said.  And to think that we just dumped Medicare ourselves on July 1!

Another interesting part in considering this PCP’s story of leaving Medicare in January is that she is probably not planning on going after Meaningful Use incentive money, an idea that I’ve nearly given up on as well given the complexities involved, in particular, to my current situation.  But that’s a completely different story for a different day.  At any rate, read Bob’s article above.  It’s food for a hungry mind as the year in Meaningful Use progresses.

Dr. West is an endocrinologist in private practice in Washington, DC.  He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine and opened The Washington Endocrine Clinic, PLLC, as a solo practice in 2009.  He can be reached at doctorwestindc@gmail.com.  Some of his blogs also appear at EHROutlook.com.

You knew it was coming folks.   I did, too, as a matter of fact.  And so, as of July 1st, I famously exited Medicare, stage right.  Earlier in the spring, I enjoyed a lunch here in DC at Lauriol Plaza — my favorite Mexican resuarant in the District — with a personal friend of mine fairly high up in HHS who works on MU rules.  At one point, when we were discussing the highly cliche will-they-or-won’t-they cut Medicare/Medicaid payments, he rhetorically stated with eyebrows raised, “Think about it, the money’s got to come from somewhere.”  The clear implication being that it will logically come from cutting from doctors’ payments.

Now, the New York Times reports this post, discussing the compromises that the Obama administration is proposing to make by cutting CMS payments for services to seniors in exchange for the Republicans allowing them to raise taxes to solve the budget crisis.

Suddenly the $44k incentive money for using EHRs is looking quite pale.  E-prescribing for 2%?  Pee-shaw!

Dr. West is an endocrinologist in private practice in Washington, DC.  He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC, as a solo practice in 2009.  He can be reached at doctorwestindc@gmail.com.

Let’s get real for a moment, shall we?  I just read a post about the AHA blasting CMS for supporting payment cuts to help balance the budget.  At the same time, CMS is offering all of this “free” money in the form of incentive payments for incentivizing doctors to buy expensive electronic medical records systems to get an extra $2 per $100 billed.  So is CMS interested in giving doctors more or less?  I’m a bit curious here, as I’m sure many others are as well.

Let’s see.  In January 2012, the SGR formula for payment reductions to doctors will cut off 29%, or $29 per $100 billed.  If you add back $2 per $100 billed, you get a net loss of $27 per $100 billed by doctors.  Even if you get $44K back from CMS over 4-5 years, this would really only cover the cost of setting up the EMR equipment, if that.

Although most of my patients are pretty tuned-in and tell me how much they understand “completely” why I am opting out of Medicare as of tomorrow, July 1, I still periodically get a few questions from other patients, asking, “What’s so bad about Medicare?”  Maybe I’m nuts, but in my mind this really makes a statement about the different levels of enlightenment out there among the general public regarding why some doctors are opting out of Medicare these days.

Dr. West is an endocrinologist in private practice in Washington, DC.  He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC, as a solo practice in 2009.  He can be reached at doctorwestindc@gmail.com.

Katherine Rourke gets another gold star from me for her May 16 post, “Health IT Expenses Burden ACO Startups, But CMS Doesn’t Get It”.  I have this funny suspicion that there are a lot of things that CMS doesn’t get, and most of them involve marrying efficiency with smartly constructed programs.  As a provider who has decided to opt out of Medicare, part of what led me to make this decision were the inefficiencies involved in trying to work with a government-run program whose priorities do not include customer service.

A case in point is the new drug Prolia, used for treating osteoporosis and preventing potentially life-threatening fractures.  Yesterday, I found out that Medicare — unlike commercial insurance companies – does not authorize the use of specialty pharmacies, which can ship the drug to doctors and directly bill Medicare themselves.  Thus, I am forced to shell out around $850 for a single dose to be sent to me to give to the patient.  I then bill Medicare and hope all goes well and there are no delays with reimbursement.  Needless to say, I would be hard pressed to offer this therapy in the future to Medicare patients if I were continuing with it.

And what’s with calling an HMO established by CMS an ACO?  Is this just a clever ruse to diguise exactly what an HMO does?: keeps costs down by paying less and causing the patient to, thus, get less?  My old 8th grade high school teacher Ms. Rainey, bless her soul, used to have the most apt quips when we would come to her class every day.  And she was so right, again and again.  One morning, she told us the story of her son who bought a pair of sneakers at Payless Shoe Source.  In about two weeks, they were falling apart.  Her comment?   “Pay less, get less.”

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC, as a solo practice in 2009.  He can be reached at doctorwestindc@gmail.com.