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Readers Write 04/05/10

April 5, 2010 Readers Write 14 Comments

Submit your article of up to 500 words in length, subject to editing for clarity and brevity (please note: I run only original articles that have not appeared on any Web site or in any publication and I can’t use anything that looks like a commercial pitch). I’ll use a phony name for you unless you tell me otherwise. Thanks for sharing!

Has Meaningful Use Already Lost All Meaning?
By Cynthia Porter


The release earlier this year of expanded meaningful use requirements has gotten the healthcare IT community in quite a tizzy. The phrase was on everyone’s lips before, during, and after HIMSS. It was obvious to me

  1. Everyone has a strong opinion about it;
  2. Not everyone understands it; and
  3. The recent passing of healthcare reform has left providers extremely anxious about how they and the vendors they do business with will comply with “it”, depending on what “it” ultimately turns out to be.

I know for a fact that hospital executives’ concerns about their institutions’ abilities to meet requirements and the overly aggressive timetables released as part of the expanded meaningful use requirements has increased exponentially since 2009, when the HITECH Act was initially released.

Nearly 80 percent of 150 hospital executives recently surveyed by Porter Research noted an increased rate of adoption for e-prescribing, patient portals, and EHRs. That’s a 20% increase from 2009, before the expanded requirements were published. So it’s safe to say that providers are jumping on the bandwagon.

Most, however, are worried that the wheels are going to fall off because vendors won’t have enough qualified employees and/or up-to-date resources to meet demand and requirements. One CIO we interviewed believes vendors “will be forced to spend more programming hours around the interoperability and security of their software versus the primary function, which is taking care of patients and making it easier for clinicians to utilize.”

And there’s the rub. Sure, the healthcare IT community will probably benefit from the political machinations going on in Washington, but will the patients? Will vendors rush to provide hospitals with technologies that could have used a few more months of development and trial? Will hospital staff have time to adequately train their IT people to use these new technologies? Will patients pay the price for a rush job?

It’s unfortunate that time will tell, because time is one thing patients don’t have.

Cynthia Porter is president of Porter Research.

Health Reform, Schmealth Reform – Freakin’ Pay Me
By Gregg Alexander

Down here in the primary care trenches, where the pudding meets the pavement (or some such mixed analogy), no matter how much we may want it to, health reform doesn’t seem like it will ever really get to addressing our needs.

What do I mean by that? Simple enough: it is getting virtually impossible to justify staying in traditional primary care any more and, health reform or no, HITECH or no, Congress just walked away and forgot about me and mine.

Despite our efforts to help bring the best we can to those we serve, what do we get? People, be they private insurers or Medicaid, self-pay or no-pay, hospitals, and even IT folks, all telling us what we can and can’t do. We’re told when we are and aren’t allowed to make medical recommendations based upon our knowledge and experience and then we’re told just how much we’re allowed to charge for our expertise. (Disregard whether or not we’ll even get paid anything at all for our time and trouble.)

We fight to get what we believe is appropriate care for our patients, regardless of their insurance or lack thereof. We struggle to make ends meet so that we can offer the advantages of a quality medical home and, perhaps, digital healthcare information management to our patients. We work far too many hours, away from our family and friends, just so we can feel good enough to sleep at night knowing we have done our best to help those who come to us for care.

And then…and then…Congress goes on break before postponing a 21.3% cut in Medicare payments. (Thank you, Senator Tom Coburn, R-OK.) Whether or not they repeal it when they return, CMS will likely withhold payments for at least 10 days before beginning to process those 21.3% reduced payments. For those affected, continuing this Sustainable Growth Rate (SGR) formula is anything but sustainable and quite the opposite of growth.

Ladies and gentlemen, if you’re not already aware, we have a shortage of primary care providers in America. Pushing us toward expensive technology adoption which may or may not truly be ready to really meet OUR needs while reducing the bottom-of-the-barrel payments with which we already struggle, is not going to solve any little piece of our giant healthcare crisis. It will make it much worse as more and more of us leave for less stressful and less beyond-our-control professional lives. All the while, we’ll leave little encouragement for the med school up-and-comers who will doubtful choose to join the ranks of careworn primary care.

Let us worry about dealing with the pressures of making medical decisions and allow us a reasonable income which doesn’t add to the strain. Elsewise…well…how long would you stick around after a 21% pay cut?

From the (weary) trenches…

“Pay me for my work, but I don’t do it for the money.” – Vanna Bonta

Dr. Gregg Alexander, a grunt in the trenches pediatrician, directs the “Pediatric Office of the Future” exhibit for the American Academy of Pediatrics and is a member of the Professional Advisory Council for ModernMedicine.com. More of his blather…er, writings…can be found at his blog, practice web site or directly from doc@madisonpediatric.com.

This Just In: HIRE Bill Signed! Could Hiring Tax Breaks Benefit Your Organization?
By Tiffany Crenshaw


On March 18, 2010, President Obama signed into law the Hiring Incentives to Restore Employment Act (HIRE). HIRE is a $17.5 billion jobs bill that the President says will bolster hiring and incent business owners, creating approximately 250,000 new jobs.

The bill was dramatically scaled back as it passed through the House and Senate, from $150 billion to less than $20 billion. Still, lawmakers say it is the first step in a series of bills designed to encourage job growth.

The Act offers two tax breaks to companies who hire recently unemployed workers, one in the form of a payroll tax exemption and the other in the form of a tax credit. Beginning March 19 and through the remainder of 2010, employers will not have to pay the 6.2% Social Security payroll tax on qualifying new hires. In addition, companies are entitled to a credit equal to 6.2% of an eligible employee’s total salary (up to $1,000) if that new hire is retained for at least 52 weeks consecutively.

To qualify for the tax breaks, new employees must be hired between February 3, 2010, and January 1, 2011. Each new hire must verify in writing that he or she was unemployed for a minimum of 60 consecutive days just prior to being hired. If the worker is replacing an employee in the same job role, he or she is not eligible, unless the previous employee was terminated for cause or voluntarily quit.

There is no doubt that these incentives may not help all companies, but HIRE is a start that could benefit your organization as well as the nation’s unemployment rate. Companies still experiencing depressed revenues due to economic slowdown may not benefit from the tax incentives, but others may find the tax savings to be a valuable advantage towards savings and growth.

Tiffany Crenshaw is CEO of Intellect Resources.

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Currently there are "14 comments" on this Article:

  1. I disagree with Cynthia Porter’s comments on Meaningful Use. So far, all that’s been published is an initial NPRM for the purpose of obtaining comments from the public. Like everybody else, Cynthia had an opportunity to make her opinion known to CMS.

    Now, we are waiting for the final publication of the requirements for Meaningful Use after all of the public comments are read. At that time, we will find out whether CMS listened to the comments and we will find out the extent of the requirements.

  2. Gregg,
    Describing the SGR adjustment as a 21% pay cut is, unfortunately, minimizing the impact. Let’s say I have a practice with 100% of my patients covered by Medicare. To pull numbers out of the blue for an example, say I typically collect $300,000 per year from Medicare, and my overhead runs about 50% of that. This leaves me with a profit/salary of $150,000. Now, if Medicare reduces my payments by 20% (I’m rounding off so I don’t have to think so hard) my collections are now $240,000 per year. My overhead still runs $150,000 (Medicare didn’t reduce that), leaving me with a profit of $90,000. This is a 40% pay cut, not 20%.

  3. RE: Has Meaningful Use Already Lost All Meaning?

    Since market pressures have not done a good enough job of getting healthcare IT to be clinically excellent and deliver on the promise of aggregate patient data, it is appropariate that the government interfere. And thus, patients and providers are already paying the price for unnecessarily inferior technological solutions. Pushing vendors and providers to meet meaningful use requirements, like any large project, will cause fear and unrest during the first clumsy steps but will yield great progress when all is said and done. The meaningful use requirements, I theorize, are a pre-cursor to healthcare software being regulated like any other medical device, and rightfully so.

  4. Dr. Alexander is correct- what HITECH will eventually do is to drive the much needed primary care physician population away from Medicare and to more lucrative, cash-only options of care, or into retirement. Those patients with the most need will find themselves waiting in line to see a CNP with an “enterprise” HITECH ready EMR that will qualify her group to receive extra payments, but with the loss of quality and with an increase in errors, opposite to what is claimed by the lobbying representatives of HIMSS. Great machines run by lower level cheap staffers will also NOT save money, and will probably lead to higher costs.

    >>> So it’s safe to say that providers are jumping on the bandwagon.

    There are many that “talk the talk” but will they eventually “walk the walk?” Probably no. Numerous studies have demonstrated that the deinstallation rate of HITECH ready “certified” EHRs is about 50%. Once these physicians downgrade to paper or to a cheaper EMR, they will often never go back. With the paycuts slated over the next 10 years in reimbursement and with the increasing complexity of the nebulous “meaningful use” criteria which bastardizes the concept of the EHR into a reporting tool rather than a tool to make the professional lives of physicians richer and easier, doctors will soon stop buying into HIT (including e-prescribing and EHR).

    Sure, there are the early adopters and those with EHRs that are trying to come around like sheep to the whims of Obama and his HIT minion lobbyists that surround him, but so far according to a “real” study, done by the Centers for Disease Control on 2/2010, there are only 6.3% of physicians using their EHRs in a “meaningful” way. As the regs become more complex, I’m sure that even this will fall.

    URL: http://www.ama-assn.org/amednews/2010/02/01/bil20201.htm

    To sum this up: we need to leave physicians alone so that they can see their patients as best as they can with the tools that they are more efficient and comfortable using.

  5. With all due respect to Dr. Borges, et al … I’m getting tired of hearing all the complaining about pay cuts. Is a single 21% cut outrageous? Of course it is. Is having the fate of hundreds of thousands of providers, their families and their employees, resting on one single senator’s vote absurd? Certainly. BUT … I don’t hear anyone complaining about the nearly 50% drop in airline costs over the past decades (in real $), or the nearly 80% drop in technology costs … these industries (and others) also have their revenues slashed, but instead of complaining, they continuously figure out a way to continue to IMPROVE their margins, NOTWITHSTANDING the revenue reductions. I have yet to see a single physician practice where I could not improve TAKE HOME pay by 50%, 100%, or more … simply by correctly deploying a combination of technology, workflow improvement, and simple management process that has existed for years in other industries. Frankly, the stimulus is a waste of taxpayer money … there’s plenty of ROI without it. When will physicians stop playing victims and wake up to the reality that they can embrace this change and capitalize on it?

  6. @ Really?

    You are right. But don’t forget Dr. Borges is wrong. There is no 21% pay cut.

    Dr Borges was writing about this in 2008, and he still has not had his paycut.


    Then it was 10%. Now it’s 21%. It will not be settled for at least 2 years. Expect to hear about it until then.

  7. AlexG thanks for a more balanced view of the SGR formula legislation. At least you were not saying it’s because of the health bill. However the extension was passed, again. As it is every year. Senator Tom Coburn, R-OK did block it. The extension was passes until October 1st.


    We will still not see real action on October 1st. An extension will again be passed. As it has for nearly a decade.

    It amazes me that people who say they believe there is a 21% pay cut on the line, seem to be so out of touch with the actions of the Senate on this very issue. If they were so concerned, wouldn’t they at least check the press?

    The adjusted payment schedule will pass. Why? Because there is almost unanimous support for it.

    “Most members of Congress agree that Medicare payments to physicians are too low, but the issue of how to pay for the increases is tangled up in the overall debate of how to reform the American healthcare system, now stalled in Congress.”

    The argument is about how it should be passed, the details. It’s how our government works.

    The people against it are the “big government” types. However their bark is louder than their bite. This “government run” $10 Billion healthcare program offends them, when it suites them.

    As for the primary care shortage. Doctors, with huge student loans, go in to higher paying specialties. The balance of pay needs to change. There need to be more incentives to go in to primary care. This fact is of course mobilizing specialists. That’s the real story you are not hearing.

  8. @copyright Depends on how long you have been out of work from Epic and whether your non-compete expired? Could be nowhere in HIT, but perhaps the fast food industry…

  9. Wonderful comments by all three. A. Borges’ are well stated.

    Defend the integrity of medicine.

    In your prior blog report, a patient died at Harvard Partner’s System (MGH) from bradycardia while the nurses ignored the monitors and in Nebraska, a patient died from heparin.

    I thought these errors were to be cured by HIT.

    What does Berwick have to say about the Harvard death? The nurses washed their hands (of the patient for 20 minutes).

    In order to protect the snactity of the doctor patient relationship and the privacy of your patients’ most private information, the best strategy is don’t buy these systems.

    Do not get suckered in to the government’s enticements, kickbacks, and threats. This has got to be illegal.

    Take good care of your patients, unsubscribe to Medicare and other Federal Health Insurance Programs and do not allow your patients’ information to be compromised.

  10. To “Really? Says:”, There is a significant difference between the ability of an airline to adjust/cut/slash it’s costs and change it’s business model to that of a physician practice which is more like a small business that doesn’t necessarily have “experts” on staff to help them figure out all the technology options. How many can even fix their PCs and printers when they have problems?

    If you’ve ever filed an insurance claim to the various commercial carriers and, worse, the government payers, and then tried to collect the balances due from patients, it’s not hard to understand the frustrations expressed by primary care physicians who don’t have the income margins specialty care providers have. These guys don’t just slash a percent of their employees; they close the doors.

    Since many in congress don’t believe health care can or should operate in the free market and pass laws to “regulate” the reimbursement without having any knowledge of the real-world consequences, we should expect, and hope for, many more physicians to cry out, hoping someone is listening.

    Don’t be fooled; the rationing of health care began long ago when CMS and Medicaid programs started saying “We will only pay X dollars for this procedure”, or “That is not a covered charge”. Were there exorbitant charges in the “fee-for-service” days, yes. Those days are long gone in most areas of medicine. Now we have potential physicians deciding they can make more money in law or investment banking. Let’s face it, those that are smartest (smarter than me) can pick any career that suits them. Unfortunately, that leaves the less smart to work on us when we need health care. That doesn’t appeal to me. There’s got to be a better way.

    Let’s get ALL of the smart people in a room, particularly those that know health care, instead of a bunch of congressional lawyers, and figure out a sustainable plan.

  11. @Architect
    I’m doing a masters degree in something else but thought I might pickup some extra cash by working part time on projects. I left a year and a half ago.

  12. Blah, your news item is dated March 11th. Here is one (of many) dated after that time which seems quite contradictory: The Voyager Thus, Kiddoc and I, among many others may be confused, but either way, trying to make business plans in the face of this never-ending threat is at least a challenge and certainly nerve-wracking.


    Really, “Really?”? I run a pretty high tech practice, try to keep up on good practice management and advanced workflow ideas, and even earned my bachelor’s in “Rural Healthcare Management.” However, if you can show me how, here in small town Ohio, to bring “50%, 100%, or more…” home to my lovely wife, I know she and I both would be happy to split it right down the middle with you!

  13. Really? >>> I don’t hear anyone complaining about the nearly 50% drop in airline costs over the past decades (in real $), or the nearly 80% drop in technology costs … these industries (and others) also have their revenues slashed… blah blah blah

    These are enterprises run by free market pressures, not controlled by big government or the insurance industry! Big difference. With Medicare, CMS/big government tells docs to slash their bottom lines by 21% of their gross incomes, which amounts to about 42% of their net income… take it or leave it. On top of that, the medical industry is the only one where price fixing is allowed- when Medicare cuts back, do does every other insurance company, most all of which pay an amount which is pegged at an even smaller percent of Medicare.

    The healthcare industry is the only one where there is a shortage of providers, yet the only ones working can’t increase their prices at par with the increased demand. Go to Orbitz and try to buy a last minute airline ticket and you’ll end up paying 3 times more what someone 2-4 months previously paid. Demand is the engine of the free market, which nowadays doesn’t exist in healthcare.

    Really? >>> simply by correctly deploying a combination of technology, workflow improvement, and simple management process that has existed for years in other industries.

    I betcha you believe in Santa Claus and the tooth fairy too… Over 50% of doctors now use EMR technology. Most of us own numerous computers, printers, top-of-the-line cell phones, and other technology. Others do well without the need of technology. At the current time, after 20 years of HMO and Medicare cutbacks most offices are optimized to the core.

    BTW, I agree that the stimulus concept is a waste of money, but if less than 10% of docs end up participating in a 100% “meaningful way” as I believe will happen, though, then the HITECH money may well NOT be spent at all.

    >>> embrace this change and capitalize on it?

    Yuck- I’ve been hearing this socialist banter from Obama for the past 15 months! The only change I want to see is the one in the White House in 2012…

    >>> borgewah Says: “But don’t forget Dr. Borges is wrong.”

    Winston Churchill: “It is better to be irresponsible and right, than to be responsible and wrong.”

    I always try to be responsible and right… (an Al Borges quote)

    The reality is that there is a massive paycut looming, which is why CMS/Medicare had to freeze physician pay starting 4/1/2010 to avoid a catastrophic physician exodus from Medicare. You can read about it here:

    “What to Do on Day One After the Medicare Cuts”

    emrupdate- what memories indeed! I’ve posted almost 5000 posts at emrupdate through 2009. I’ve moved on for 2010 to bigger and better platforms, s.a. Histalk. 🙂


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Reader Comments

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