Despite the government’s bribe of nearly $27 billion to digitize patient records, nearly 70% of physicians say electronic health record (EHR) systems have not been worth it. It’s a sobering statistic backed by newly released data from marketing and research firm MPI Group and Medical Economics that suggest nearly two-thirds of doctors would not purchase their current EHR system again because of poor functionality and high costs.
In a surprise finding, nearly 45% of physicians from the national survey report spending more than $100,000 on an EHR. About 77% of the largest practices spent nearly $200,000 on their systems.
While physicians can receive $44,000 through the Medicare EHR Meaningful Use (MU) incentive program, and $63,750 through Medicaid’s MU program, some physicians say it’s not nearly enough to cover the increasing costs of implementation, training, annual licensing fees, hardware and associated services. But the most dramatic unanticipated costs were associated with the need to increase staff, coupled with a loss in physician productivity.
“We used to see 32 patients a day with one tech, and now we struggle to see 24 patients a day with four techs. And we provide worse care,” said one survey respondent.
While some physicians cited benefits of accessing patient data, availability of practice metrics, and e-prescribing conveniences for patients, most physicians do not believe these systems come close to creating new efficiencies or sharing data with multiple providers or improving patient care.
In fact, when doctors were asked if their EHR investment was worth the effort, resources and cost, “no” was the reply given by nearly 79% of respondents in practices with more than 10 physicians.
Medical Economics’ survey results, based on responses from nearly 1,000 physicians, were corroborated by the findings of a January 2013 RAND Corp. study, detailed in Health Affairs, The New York Times, USA Today, and other national media organizations, criticizing the usability and interconnectedness of current EHR systems.
“The failure of health information technology to quickly deliver on its promise is not caused by its lack of potential, but rather because of the shortcomings in the design of the IT systems that are currently in place,” says Art Kellermann, MD, MPH, the study’s senior author and the Paul O’Neill Alcoa Chair in Policy Analysis at RAND.
Another 2013 RAND report, titled “Physician Professional Satisfaction and their Implications for Patient Care,” concludes that frustrations related to EHRs are negatively influencing physician attitudes about their careers.
“Poor EHR usability, time-consuming data entry, interference with face-to-face patient care, inefficient and less fulfilling work content, inability to exchange health information between EHR products, and degradation of clinical documentation were prominent sources of professional dissatisfaction,” the report says.
- See more at: http://medicaleconomics.modernmedicine.com/medical-economics/news/physician-outcry-ehr-functionality-cost-will-shake-health-information-technol#sthash.MJCOgUKs.dpufhttp://medicaleconomics.modernmedicine.com/medical-economics/news/physician-outcry-ehr-functionality-cost-will-shake-health-information-technol
MONDAY, FEBRUARY 10, 2014
More Obamacare Unravelling
On Friday, I asked if Obamacare was unraveling.
The Obama administration announced today that they are delaying the employer mandate again.
In the announcement, they said that large employers, those with at least 100 workers, will only have to cover 70% of their otherwise eligible workforce in 2015 and 95% in 2016 and beyond.
The administration also said that employers with 50 to 100 workers will have their mandate to provide affordable health insurance to their workers delayed until 2016––one more year's reprieve.
Employers with less than 50 workers, not required to provide coverage by the Affordable Care Act, will be exempt from the original reporting requirements in 2015 and every year thereafter.
Democrats have been under increasing political pressure from employers back home because of the reporting requirements as well as the mandate that employers with more than 50 workers offer coverage. No doubt Congressional Democrats have been pressuring the administration to back off on the requirements with an election approaching in the fall.
But it is hard to figure out just where the Obama administration is going with all of this.
For employers with more than 50 workers this is a delay not a fix. Employers will only now up the pressure to change the law completely, knowing they have the administration on the political run over these issues. And, small employers will still have to comply with the very costly minimum benefit mandates––really the biggest complaint they have had. Just exactly what is the Obama administration accomplishing with a delay?
What will the administration back off on next? Given the very small exchange enrollment so far coming from the ranks of the uninsured, will they next postpone or eliminate the individual mandate?
No one has been more critical of the various requirements in Obamacare that I have.
But to make an insurance system work you have to have a set of consistent and consistently applied rules. You can't have some people choosing to be out today and in tomorrow. You can't have a system where insurers price products based upon one set of conditions and then you keep backing off on the conditions consumers and employers have to follow.
The administration really has three options:
The Obama administration announced today that they are delaying the employer mandate again.
In the announcement, they said that large employers, those with at least 100 workers, will only have to cover 70% of their otherwise eligible workforce in 2015 and 95% in 2016 and beyond.
The administration also said that employers with 50 to 100 workers will have their mandate to provide affordable health insurance to their workers delayed until 2016––one more year's reprieve.
Employers with less than 50 workers, not required to provide coverage by the Affordable Care Act, will be exempt from the original reporting requirements in 2015 and every year thereafter.
Democrats have been under increasing political pressure from employers back home because of the reporting requirements as well as the mandate that employers with more than 50 workers offer coverage. No doubt Congressional Democrats have been pressuring the administration to back off on the requirements with an election approaching in the fall.
But it is hard to figure out just where the Obama administration is going with all of this.
For employers with more than 50 workers this is a delay not a fix. Employers will only now up the pressure to change the law completely, knowing they have the administration on the political run over these issues. And, small employers will still have to comply with the very costly minimum benefit mandates––really the biggest complaint they have had. Just exactly what is the Obama administration accomplishing with a delay?
What will the administration back off on next? Given the very small exchange enrollment so far coming from the ranks of the uninsured, will they next postpone or eliminate the individual mandate?
No one has been more critical of the various requirements in Obamacare that I have.
But to make an insurance system work you have to have a set of consistent and consistently applied rules. You can't have some people choosing to be out today and in tomorrow. You can't have a system where insurers price products based upon one set of conditions and then you keep backing off on the conditions consumers and employers have to follow.
The administration really has three options:
Opting Out Of Medicaid Expansion: The Health And Financial Impacts
January 30th, 2014
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The Affordable Care Act (ACA) was designed to increase access to health insurance by: 1) requiring states to expand Medicaid eligibility to people with incomes less than 138 percent of the Federal Poverty Level (FPL) ($19,530 for a family of three in 2013), with the cost of expanded eligibility mostly paid by the federal government; 2) establishing online insurance “exchanges” with regulated benefit structures where people can comparison shop for insurance plans; and 3) requiring most uninsured people with incomes above 138 percent FPL to purchase insurance or face financial penalties, while providing premium subsidies for those up to 400 percent of FPL.
Recent studies suggest that Medicaid expansion will result in health and financial gains. Older studies also found salutary health effects of expanded or improved insurance coverage, particularly for lower income adults. These studies also document an increase in utilization of most health care services. Most recently, the Oregon Health Insurance Experiment (OHIE) found a striking increase in emergency department use as well as other outpatient care.
The Supreme Court ruled in June 2012 that states may opt out of Medicaid expansion, and as of November 2013, 25 states have done so. These opt-out decisions will leave millions uninsured who would have otherwise been covered by Medicaid, but the health and financial impacts have not been quantified.
In this post, we estimate the number and demographic characteristics of people likely to remain uninsured as a result of states’ opting out of Medicaid expansion. Applying these figures to estimates of the effects of insurance expansion from prior studies, we calculate the likely health and financial impacts of states’ opt-out decisions.
The Consequences of Opting Out
Work and Health Insurance: Is There An Alternative?
Three blog posts and a column should probably suffice to cover the debate over Obamacare and work incentives, but I don’t want to let the topic drop without first stepping back and talking about the actual health policy disagreement here. My column and posts last week criticized what struck me as a kind of insouciance from liberals about this issue, shading into a post-work utopianism that doesn’t wrestle with what, in practice, the decline of work is actually likely to mean for issues of class, mobility, and social equality. But it’s also important to recognize that for many liberal writers, the controlling assumption here is not anti-work or pro-work. It’s just pro-universal health care as a basic standard for a decent society, with the consequences taken as they come.
I would prefer that this perspective was accompanied by less chatter about how the only people working less because of Obamacare will be The Most Hardworking Amazing Moms in America, and fewer suggestions that it’s indecent and unpatriotic to worry about how welfare policy influences economic decision-making. But stripped of the Panglossian window dressing, it’s entirely reasonable to believe that some public goods are too important to be withheld just because they might have a few perverse consequences. (I can certainly think of a few policies I would support even if they took a bite out workforce participation.)
At least where the center-left is concerned, then, if you dig deep enough into the work-incentives debate you’ll hit the same old argument about the importance of universal comprehensive insurance. That’s why you keep seeing Obamacare’s defenders argue that the law’s income effect — where people work less because they’re getting insurance benefits at a much-reduced cost — is mostly fine, because we don’t want people having to work to afford a basic good like health insurance. And it’s why, when they talk about the substitution effect — the way the the subsidy phase-out creates an effective marginal tax that discourages working longer hours or taking a higher-paying job — they usually concede the existence of a problem, but then argue that the best way to solve it would be to extend Obamacare’s existing benefit further up the income ladder, or make it universal … in each case, at an expense that conservatives would inevitably oppose.
What’s being implicitly ruled out, in both cases, is the possibility that government should be subsidizing insurance, but also subsidizing less of it than Obamacare does, and that the scope of the existing insurance model is making both the income and the substitution effects larger than they need to be. This is basically the theory behind the most plausible conservative alternative — a flat subsidy for catastrophic coverage — to the health care law we actually got. And though liberals mostly reject it, I think it’s a theory worth entertaining even if you believe absolutely in the kind of redistribution inherent in Obamacare … because even granted the pro-redistribution premise it’s still not obvious that subsidizing comprehensive insurance is the best way to go about it.
Think about it this way. The welfare state delivers a basket of subsidies to lower-income Americans. Some of these subsidies take the form of cash, and some are direct subsidies for various goods (food, housing, health insurance). Some are tied to work — the earned income tax credit is the notable example — and some of them are not. Pre-Obamacare, the main subsidy for health insurance was tied to work, which both conservatives and liberals tend to regard as a less-than-ideal design; it was also open-ended and regressive, making it a lousy deal for low-income Americans, period.
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