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EMRs costly to health system

A recent New York Times article caught my eye the other day.  The author focused on the seeming corruption of physicians bilking patients out of tons of money for unnecessary procedures and the havoc wreaked on the American public as we try to keep the rising costs of healthcare down.

The most interesting part of the piece was the amount of blame placed on doctors as the culprits (which in the extreme examples cited was probably warranted).  Of course, as an industry insider, I can tell you that there was so much under the surface that the writer either failed to comprehend, did not know about, or simply chose to ignore.  Judging by the comments from medical providers, I wasn’t alone in my thinking.

Although not her fault, the author bought into MGMA data that was grossly wrong, for example.  I can’t imaging too many dermatologists making just $175,000 annually in 1995.  From a wasted $800 fee that my clinic had to pay to gain access to a data set when we tried to offer a competitive salary to an endocrinologist in our clinic in 2011, I can tell anyone that the data we viewed grossly overestimated the average endocrinologist salary.  The MGMA data we bought was based on only 15 doctors in only 5 practices in the entire mid-Atlantic region who were apparently making an average of over $300,000 annually.  A Medscape survey quoted a more believable $168,000 annually for an endocrinologist.

I have to apologize for the rather longwinded intro to my EMR thought of the day, which is the cost of EMRs to the healthcare system in America. It seems that not too long ago it was much cheaper to use paper charts. Currently, most EMR systems are simply expensive recording tools. Some of them don’t even really generate insightful or easy to read medical notes, although what they do produce may be argued by some EMR vendor companies and end users to be some form of documentation that loosely qualifies for generating a bill for an office note or medical procedure (wide spectrum of quality here).

Some EMR systems are free but most are costly, either lump sum up front with ongoing annual maintenance fees, or pay-as-you-go monthly rentals of depository databases where data from medical notes is stored. Why is the medical establishment wasting all of this money when research has shown again and again that EMR systems do not produce more safety or efficiency of providing healthcare for anyone?

With incentive programs from the US government driving and pushing doctors to set up their own EMR systems for the past 4-5 years, unfortunately, this has been a horribly misguided, misplanned, and costly experiment by probably well meaning individuals who found it un-PC to admit their mistakes. Personally, I wish the government had stayed out of it and let the market forces do what they do best, provide cheaper and cheaper hardware and software options over time until the value of EMR systems eventually sunk or swam the market on their own.

I personally use a free version of an EMR system, which works fairly well (with various glitches here and there during periodic system upgrades). However, I am in the minority since most of my colleagues in the Washington, DC area are either still working on paper charts or have shelled out gazoomba bucks to use a costly EMR system. I am willing to wager that the DC market is not too different from everywhere else in America in that respect. Although I love my EMR system for its organization and ability to electronically prescribe medications with a few clicks of the mouse, I think it remains equally important to consider that the EMR experiment in America is largely failed to produce any significant tangible results and only costs the entire system more, which in the end will be passed on to the consumer.

No EMR system makes doctors more money. The carrot and stick incentive model that the U.S. government used to promote EMR use is small and will be short lived. With ongoing EMR costs to medical providers, this technology has already begun placing another money suck on the healthcare system. Paper and ink are far cheaper by simple math. The only way it makes fiscal sense to continue the EMR market as a cost saving measure is to make all EMR systems of zero cost to the medical providers who use them, which will probably never happen. This is the only way that additional costs cannot be passed on to patients (cleverly couched, of course by well meaning doctors who need to keep their own costs down). Challenging as it may seem, I am hoping that someday someone can think of a positive solution to this important problem.

January 21, 2014 I Written By

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 in 2009. He can be contacted at doctorwestindc@gmail.com.

CMS to cut healthcare payments by 30% in January 2012

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.

July 7, 2011 I Written By

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 in 2009. He can be contacted at doctorwestindc@gmail.com.