There’s an intruder in many doctors’ examination rooms these days. The intruder is a laptop computer.
The intruder was introduced in the 2009 stimulus bill, pre-ObamaCare, when the federal government instituted a mandate that all medical providers that accept Medicare must adopt Electronic Health Records (EHRs) by 2015 or suffer fines. The fines started at 1% of Medicare reimbursement fees and will increase to 5% over ten years.
The excuse for this unprecedented intrusion into the practice of medicine was a series of myths that purported to explain the necessity of this mandate. Among these myths were the following:
- Reducing medical errors
- Increasing the efficiency of medical practices
- Lowering the costs of healthcare
- Improving the quality of healthcare by delivering “evidence-based medicine”
I’ve been writing on this issue since 2015 and a review of recent data in 2017 shows that nothing is improving. Here’s what I said in 2015:
“My own experience refutes all of these claims. When my local hospital instituted EHRs I found an increase in medical errors due to nursing mistakes and computer errors, a decreased efficiency in the routines of hospital care and treatment of patients, an increase in the costs associated with providing care for personnel and technology, and no evidence of improved quality. I conducted my own non-scientific surveys of my colleagues and found they had similar experiences.”
A 2014 survey by the industry group Medical Economics discovered:
- 67% of doctors are “dissatisfied with EHR functionality.
- 73% of the largest practices would not purchase their current EHR system
- 45% of respondents say patient care is worse
- 65% of respondents say their EHR system results in financial losses
Recent surveys show that nothing has really changed. Roughly two-thirds of physicians are still dissatisfied with their EHRs and do not think that they improve quality of care.
Why does the government insist on these expensive, inefficient intruders in our healthcare system?
The answer is government control. The Obama administration believed strongly in government control of healthcare and implemented these changes in our system to provide the control they wanted.
Why don’t physicians just stop using their EHRs?
Two reasons come to mind. The high cost of implementation and the current demands of the system that penalize doctors for non-compliance. The latest of these is the Medicare Access and CHIP Reauthorization Act of 2015 or MACRA. MACRA was passed to eliminate the Sustainable Growth Rate (SGR) that dictated automatic cuts in physicians payments (20-30%) for Medicare that hung over the heads of medical practices from 2003 to 2015. Each year Congress had to pass an override of SGR to avoid a dramatic collapse of Medicare if these cuts took place.
Sally Pipes, writing in Forbes, explains that MACRA is just camouflaging the same government intrusion into healthcare that began with the EHR implementation. She says, “The centerpiece of the rule is a draconian compliance scoring system that pits small medical practices against large healthcare institutions to compete for a place on the upper half of the MACRA compliance bell curve. Physicians on the lower half of the bell curve who do not meet the requirements must pay penalties to cover the incentives paid to physicians in the upper half who meet more of the requirements.”
According to the Center for Medicare and Medicaid Services (CMS), 87 percent of solo practices and 70 percent of practices with 2-10 physicians will receive penalties under MACRA.
Physicians in independent practices cannot compete so they are being driven into the arms of hospitals that hire them. The hospitals can then charge higher fees for the same services these physicians performed for less in their private practices. Costs therefore increase for consumers and quality suffers as care is depersonalized and computerized.
I have always opposed EHRs in my practice because they are expensive and intrusive in the doctor-patient relationship. Now we know they are also being used as a cudgel to drive independent physicians into the waiting arms of hospitals – to increase the hospital revenues and the government’s control of healthcare.
To change this dynamic the Trump administration should call for making participation in MACRA voluntary. Pipes puts it this way:
“Dropping the penalties and preserving the incentives will allow MACRA devotees to continue their work while unshackling other doctors from unproven quality measure and HER mandates. Every physician, MACRA supporter or not, will be free to pursue his or her own vision of health information technology – the one that is best for patients.”
It is time to switch the emphasis from government control of healthcare to patient-centered physician control of healthcare. Who knows better what’s best for the patient?