Adopt EHR or else- Unveiled Threats for Progress

Rewarding healthcare facilities and physicians with reimbursement incentives to convert records to an electronic system and go paperless might have gone by the wayside with Medicare reimbursement declines. So, other incentives may come into play….like “threats”.  Adopt electronic medical records or lose your license to practice medicine.  This is what Massachusetts is currently looking to do- making meaningful use EHRs a requirement for obtaining a medical license (or keeping one).  So, today’s choice may not even be a choice in the future!

John Glaser, adviser to the Office of the National Coordinator for Healthcare Information Technology (ONC) states “We’re going to go through a hell of a lot of change in healthcare IT in a relatively short period of time.  Some states will screw it up”.  He feels that some information exchanges won’t work and that the road ahead will be bumpy.

Medicare scaled back further- will Others follow suit?

The Medicare debate and the whim of Congress is sending a message that Medicare is or will be very unreliable. Physicians who depend on Medicare by as much as 31% of income to cover expenses will (or are currently) questioning the wisdom of being providers of Medicare. Although the promise of a permanent “doc fix” is in the air, it has also been circulated that Medicare funding will be depleted by 2017. (and this was before 54billion dollars was removed from Medicare to fund other programs).
Where will this leave Seniors? Where will this leave the rest of us?

More bad news is that Centers for Medicare and Medicaid Services recently announced a proposal  to cut preventive services by 6.1%, part of the implementation of the Patient Protection and Affordable Care Act (PPACA) of 2010 on or after Jan. 1, 2011.
As tragic as this is, will all other insurance plans be following suit?  This will be a real catastrophe!

Medicare Reprieve For Now, But May be Short Lived

Today President Obama signed into law the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010, more commonly known as the “doc fix”.This defers the slashing of Medicare reimbursements to doctors by 21.3% for services rendered as of June 1. However, this “reprieve” is only in effect until November.

Mr. Obama stated “I believe we need to permanently reform the Medicare formula in a way that attacks our fiscal problems without punishing our hard-working doctors or endangering the benefits on which so many of our seniors rely”.

Although grateful that the cuts have been staved off, most healthcare providers and leaders of organized medicine are repulsed by the lack of a permanent solution. According to Lori Heim, M.D., president of the American Academy of Family Physicians, “piecemeal approaches merely continue the uncertainty about the reliability of Medicare”. “The stability of federal payment is crucial to the success not just of Medicare but health reform as well. The health reform legislation calls on physicians to invest in changing their practices with health information technology, with new practice models that take time and money to implement, with new accountability standards and performance measurement reporting. Physicians can’t invest in change if they can’t count on payment for their services.”

Upon the termination of the new bill in November, Medicare cuts are slated to be slashed by 23% and then elevated to 30% by January.

It is clear that most physicians are uneasy about the shaky, temporary stability of Medicare reimbursements. For those doctors that still accept payment of Medicare, many are reevaluating their situation. They are weaning themselves from the system by decreasing the number of Medicare patients they see, limiting the practice by not accepting any new patients and seriously considering separating themselves out of fear from reliance on the government program.

For many physicians, the decrease in Medicare reimbursement is more than just a diminishing of salary despite increased expenses. It is a fight for economic survival to keep their doors open. This is one more nail in the coffin of private practice as we know it.

Mark your Calendar-the Death Knoll will Ring

The year is 2017 -significant for the death knoll time when the Medicare Hospital Insurance Trust Fund will be completely exhausted.  Not only has this not been affected by the healthcare reform legislation, savings are actually being taken from the Medicare fund to financially support new entitlements for younger Americans.

This short-sighted fiasco will put the burden on families to take care of ailing parents and grandparents.  Worse yet, the  lack of funds may very well be responsible for shutting down insolvent hospitals across the country.

Is this the healthcare reform that the government had in mind?

Medicare gets Legislative Pardon for Now

In the “eleventh hour”, the Senate approved the same proposal that it had rejected the day before to delay the 21.3% slashing of Medicare reimbursement fees along with 2.2% payment increases.  Albeit, the reprieve is only for 6 months and brokered by  Senate Finance Committee Chairman Max Baucus (D-MT)

The Center for Medicare and Medicaid Services had held up physician claims for the month of June, hoping that Congress would stop the reduction retroactively.

The House of Representatives must still pass the measure.  The Center for Medicare and Medicaid Services acknowledges that because many health facilities and physician offices rely on Medicare for 30% of their reimbursements, Medicare’s delayed processing the uncertainty about the fee cuts and delayed processing of Medicare claims may have created cash-flow problems.

“The reduction in payments, even if temporary, creates havoc for practices,” the American College of Physicians said in a statement. “The situation is unacceptable and the frustration and anger is understandable.”

The American Medical Association (AMA) says the “Senate fiddles as Medicare burns,” and “A new patient-centered category of Medicare payment will allow seniors to use their Medicare benefit fully for the healthcare they need,” said David O. Barbe, MD, an AMA trustee.

A survey of 9000 members revealed that 17% of physicians — and 31% of primary care physicians — would limit the number of Medicare patients they see because rates are too low. AMA President Cecil B. Wilson, MD, said, “Congress is playing Russian roulette with seniors’ healthcare. Congress has finally taken its game of brinkmanship too far, as the steep 21% cut is now in effect, and physicians will be forced to make difficult practice changes to keep their practice doors open.”

According to the AMA’s survey, due to the 2  reductions in March and April, 39% of physicians delayed payments for supplies, rent, or other expenses; 17% took out a loan or line of credit to pay bills; and 17% held up paychecks or even furloughed or laid off employees, according to the association’s survey.

Such cutbacks make it less likely that medical practices will invest in health information technology and other improvements that policymakers consider vital to healthcare reform, the AMA notes.

More importantly,despite the current reprieve, many practices are reevaluating the acceptance of new patients covered by Medicare and whether to drop it completely, thereby punishing seniors further because they cannot afford to remain vulnerable,  hold their breath and pray that legislation will go their way.  So, this may be the start of the end or the death knoll for Medicare coverage as we know it.

Healthcare Bullet Dodged Temporarily-can Doctors Hold On?

Claims from physicians will still remain on  hold until June 18th according to the Centers of Medicare and Medicaid while it is seen whether the Senate rescinds the decrease in Medicare reimbursements by 21.3%.

President Obama addressed the issue in his weekly talk when he said  “I’m absolutely willing to take the difficult steps necessary to lower the cost of Medicare and put our budget on a more fiscally sustainable path, but I’m not willing to do that by punishing hard-working physicians or the millions of Americans who count on Medicare.”

In what AMA President J. James Rohack, MD, called “a symbolic, visible reminder that action is desperately needed”, members of the American Medical Association started sent signed lab coats to Capitol Hill this week.

While we all wait and hold our breath, hopefully the delay will not create a detrimental effect in terms of lack of funds to cover expenses in the “medical trenches”.

Patient healthcare mistakes may be caused by electronic medical systems

According to the Florida Board of Medicine earlier this month, electronic medical systems incorrectly used or improperly designed emr programs may actually be creating more patient care errors than the old hand-written ones that they are designed to replace.

“Doctors are being inundated by vendors who are selling newly developed electronic medical record systems, some better than others” says Dr. Steven Rosenberg, a West Palm Beach dermatologist. He further points out “I think the Department of Health needs to put out a warning to physicians that they need to look at their programs’ default settings”.

The thing is that using templates, patient encounters have stated that certain abnormalities were normal by reverting to the original defaults of the program.  Legs have been reported as fine for amputees and abnormal pap smears have been missed until the disease has spread unchecked and untreated.

With physicians being pushed into converting to electronic records or getting further reduction in Medicare reimbursements, they may also  inadvertently become involved in inefficient systems.

So, will we all be helped or harmed in the short run?

Should You Be Made to Buy Health Insurance?

Healthcare reform mandates that the individual citizen purchase health insurance. Those that do not comply by 2014 will have liens imposed on income or property for failure to purchase the coverage.

But, is this mandate constitutional?

Attorney Generals in 35 states are challenging the constitutionality of the individual valium no prescripton mandate. Lawyer Timothy Jost explained in the New England Journal of Medicine’s March 11 issue that “these resistance efforts are not about law-they are about politics.”

What do you think?

Defensive Medicine is Expensive Medicine (for a reason)

According to a new national Gallup survey of physicians, defensive medicine accounts for 26 percent of the nation’s healthcare costs–one in four dollars. Using the Centers for Medicare and Medicaid Services estimate of our healthcare at $2.5 trillion, defensive medicine drains some $650 billion per year out of the healthcare system.

Calculating 2 years at this rate shows the total amount surpassing the budget alloted to healthcare reform. 

“Doctors order unnecessary medical care because they are in fear that one mistake could wipe out everything they’ve ever worked for,” says Richard Jackson, chairman and CEO of Jackson Healthcare. “If we eliminate defensive medicine, we can make healthcare more affordable for everyone.”

Seventy-three percent of the surveyed physicians admitted to practicing some form of defensive medicine over the past 12 months.

What we should be learning from this is that healthcare reform can not be successful without tort reform.  You cannot just tell physicians to stop ordering tests when the lawyers are looking over the shoulder and asking why a particular test was not done.  “Financial consideration” does not hold up as a defense in court.

Instead of fervently changing the structure of how  medicine is meted out in this country, we should be drastically overhauling how liability is viewed.

Rather than the current malpractice structure, I propose the following.

For the healthcare provider:

  • If a physician makes a mistake in diagnosis or judgement-make retraining in that ailment a criteria for continued practice
  • If a physician is found to be totally incompetent, remove the state license

For the injured party:

  • If the person can no longer perform particular job functions, spend the money training that individual for a different occupation
  • If that person can no longer perform life functions, pay for the nursing or rehabilitative care needed (subtracting what social services, medicare,medicaid and current insurance will be subsidizing)
  • For pain and suffering- while it is tragic, no amount of money is going to take away the pain, so why award it?

Tragedy should not be the ticket to winning the lottery and should not be viewed as such. Until the legislature made up predominantly with lawyers, are willing to revamp the  legal system,( and take their hands out of their pockets)  we will be going in circles to change the cost of medical care.

Patients Action Network- Let Your Voice be Heard

The Patient Action Network is a way to let your  voice be heard regarding the healthcare reform debate and most recently about Medicare reimbursement rates and the debaucle that will ensue.

With this in mind, I am forwarding this information on to you so that you may have an outlet for action.  Don’t let government just dictate to you.  Become a part of it!

AMA

 

Dear Barbara:

With access to health care for seniors and military families hanging in the balance, what did the U.S. Senate do? They took a vacation.

That’s right. Sen. Charles E. Schumer (D) and Sen. Kirsten E. Gillibrand (D) left town without addressing a scheduled 21 percent cut to Medicare payments. A cut that threatens to deprive millions of seniors and military families on TRICARE of access to the doctors they depend on.
http://www.youtube.com/watch?v=d-TswIRXtK0

Tell your members of Congress that it is time to end their mismanagement of these important health care programs, and honor their commitment to military families and older Americans. Please make this phone call today — use our toll-free grassroots hotline at (888) 434-6200.

Visit the Patients’ Action Network to learn more about the issue.

It is long past time for Congress to find a long-term solution that does not create an even bigger problem in the future. Tell them enough is enough!