Wednesday, June 8, 2011

HIT Barriers for Small Practices

Finding ways to deal with financial and legal issues and technology barriers in adopting HIT is a major problem for small medical practices. To discuss the issues, the hearing “Not What the Doctor Ordered: Health IT Barriers for Small Medical Practices” was held on June 2nd by the House Small Business Committee’s Subcommittee on Healthcare and Technology.

As Chairwomen Renee Ellmers (R-NC) pointed out in her opening statement almost 60 percent of office-based physicians work in practices with less than ten doctors. Sasha Kramer, M.D., a board-certified dermatologist presented an in-depth view of the difficulties facing smaller practices in terms of selecting and purchasing the right technology needed for their practices.

Dr. Kramer a small solo practitioner sees an average of 100 to 125 patients per week and generates 40 to 45 percent of the practice’s revenue from Medicare and Medicaid patients. The practice located in Olympia Washington serves the metro area population and beyond with many individuals in the area having limited access to practicing dermatologists.

Two years ago, Dr. Kramer’s practice purchased an EHR system at a cost of $41,349 part of which was funded by a grant of $19,964 through the Washington Health Information Collaborative for HIT. Cash reserves paid for the remaining amount. The selection of the system required Dr. Kramer to spend over 80 hours selecting the vendor and the system. At that point, another 80 hours was added dedicated to training.

Reduction of the patient volume was a major problem during the implementation of the system and it took almost four weeks before the practice was able to return to the normal routine of 4 to 6 patients per hour.

Another major unexpected problem was that the practice was forced to reinvest in a completely new HIT system two years later after the initial system had been in place for one and a half years. The software company sent out a notice that their company had been acquired by another company and that the new vendor’s products would not support Dr. Kramer’s current network platform.

Therefore, the practice looked for an alternative vendor but even so found out that the new system would cost the practice in excess of $27,000 with $6,000 in annual charges which would have to come out of cash reserves. Aside for the money involved to purchase the new system, Dr. Kramer was annoyed that again, the practice had to take time away from their patients to implement and train the entire practice on the new system.

Even with all of the issues, Dr. Kramer fully supports the infusion of HIT into physician practices as she feels strongly that HIT is a critical component in improving the healthcare delivery system in this country. Specifically, she noted that the practice benefits from HIT in a number of ways such as:

• Each patient’s chart and information is available to the physician for each encounter and helps to accurately track drug interactions, medication refills, and past medical history
• HIT makes it much easier to communication with other providers and the practice operates more efficiently with less employee time spent pulling and organizing charts
• At the conclusion of each visit, the staff is able to send charges to the clearinghouse immediately for processing claims and also payments are quickly applied to accounts using electronic remittance

In general, as Dr. Kramer explained, dermatology practices shifting from paper to electronic records or transitioning from one vendor’s platform to another platform will have to address:

• Large patient loads requiring fast-turn around during the record transfer
• Hardware and software initial and upkeep cost issues
• By converting, there is the potential for creating even longer waiting periods for patient appointments
• There may be an additional need for specialized software to accommodate the practice

She also thinks that the Physician Quality Reporting System (PQRS), e-prescribing, and the development of ACOs will all require reporting of various disparate quality metrics. Simply understanding and implementing all of these different programs is difficult and very often overwhelming to small practices

Another important issue is the fact that in 2015, physicians will possibly face financial penalties. Physicians who do not adopt certified EHR systems to meet the definition of “meaningful use” or use e-prescribing, or participate in the PQRS, can face phased-in penalties that overall can reduce Medicare payments.

Dr. Kramer along with the American Academy of Dermatology urges the Committee to provide sufficient financial and other resources to help physicians have the resources to select and implement HIT systems, consider delaying the penalties associated with HIT adoption until such time that a functional integrated system is in place, consider grandfathering physicians of a certain age to make them exempt from financial penalties, and lastly, provide a “safe harbor” for early adopters to protect them from financial penalties related to the “meaningful use” requirement.