MA Doctors May Lose Licenses For Not Adopting Electronic Records
Friday, February 21, 2014
As the nation's health care system moves toward the adoption of health information technology, such as electronic health records (EHR), Massachusetts' Chapter 224 of 2012 requires that physicians are proficient with new technology like EHRs as an eligibility standard for licensure beginning in 2015.
The argument for electronic records is framed in terms of both cost savings and better medical care, the latter through reduced errors and by connecting into a new secure, statewide records system known as the Massachusetts Health Information Highway (HIway).
“We're both very excited about electronic medical records and have the same cautions and concerns about their use, as with everything else that adds some complexity to medical care,” responded Paula Griswold, executive director of the Massachusetts Coalition for the Prevention of Medical Errors.
“They can be the solution that creates a new problem.”
Many physicians don't legally meet EHR 'proficiency' standard
The state law pegs proficiency at the level of skill to comply with “meaningful use” requirements laid out by the Centers for Medicare & Medicaid Services (CMS).
By the Massachusetts eHealth Institute's estimate, 15,000 of the 27,000 licensed physicians practicing in Massachusetts would be able to meet that standard, while many of the remaining physicians are by law ineligible for meaningful use incentives from CMS.
Those who may not be able to qualify include physicians at academic centers who don't have office practices, some specialists, and providers who don't meet certain patient demographics.
Representatives in the state House included language last week that would clarify the requirement, and allow practicing physicians who don't use digitized health records to demonstrate to the Board of Registration in Medicine that they know how to.
That addition wasn't included in the Senate's supplemental budget bill, and so the change has moved into conference committee.
Chapter 224 seeks to contain costs
When signed into law, Chapter 224 was projected to save the Massachusetts health care system nearly $200 billion over 15 years. But there has been pushback, including from Massachusetts Medical Society President Ronald Dunlap, who pointed to the law's total administrative burden.
“Collectively, these requirements increase administrative demands, add costs to the practice of medicine, and to the health care system as a whole. They will take time away from direct patient care and drive small to midsize practices to seek alignment with larger entities that have the capacity to fulfill the requirements, potentially causing further consolidations in the healthcare market,” Dunlap testified before a Massachusetts Health Policy Commission committee earlier this month.
If not reformed legislatively, the EHR requirement could be interpreted more loosely by the Board of Registration in Medicine in forthcoming regulations.
The American Recovery and Reinvestment Act included an incentive program that has rewarded physicians and hospitals for adopting EHRs.
A 2004 report in Health Affairs found less than 13 percent of solo or small physician groups employed EHRs at that time.
Since then, between 2009 and 2012, the CMS reports EHR use nearly doubled among physicians, and more than tripled among hospitals. As of October of last year, 85 percent of eligible hospitals and more than 60 percent of eligible professionals had received a Medicare or Medicaid incentive payment.
In a 2011 peer-review of 31 studies considering the cost-effectiveness of health information technology, published in the Journal of the American Medical Informatics Association, researchers found some evidence that health technology offered cost advantages despite initial acquisition costs.
But the authors concluded, because of limited literature, that it was “difficult to reach any definitive conclusion as to whether the additional costs and benefits represent value for money.”
Disrupting the physician-patient relationship
As part of the federal move toward adoption, providers and hospitals that do not meet meaningful use program requirements will begin to face Medicare/Medicaid reimbursement penalties beginning in 2016. (The Massachusetts law goes a step further in making licenses contingent.)
Physicians say there's a disconnect between how they define good health care and how politicians and insurers do. Griswold said the safety and usability of the EHR software was important. “If it adds administrative burden and distracts doctors from paying attention to patients, it adds additional risks to patient safety.”
“As we all know, the practice of medicine has become increasingly difficult as a result of external mandates,” wrote Hayward Zwerling, an internalist practicing in North Chelmsford, in an open letter responding to Chapter 224. “These mandates specify which medicines we may prescribe, which radiology tests we can order, how many days our patients are allowed to remain in the hospital, which CME classes we must take, etc. And now, the politicians intend to tell physicians which software they must use in their office and which EMR options must be utilized during the office visit.”
The president of ComChart Medical Software, Zwerling said a well-designed records system was a useful tool for many practices. “However, the federal and state government’s misguided obsession to stipulate which features must be in the EMRs, and how the physician should use the EMRs in the exam room places the politicians in the middle of the exam room between the patient and the physician, and seriously disrupts the physician-patient relationship,” he continued.
Related Slideshow: Massachusetts Emergency Care Report Card
The American College of Emergency Physicians released America's Emergency Care Environment report for 2014 in January, issuing report cards for each state in the U.S. Massachusetts ranked second overall - see the Bay State's report card grades and highlights in the slides below.
Access to Emergency Care Highlights
* Board-certified emergency physicians per 100,000 population: 14.2
* Emergency physicians per 100,000 population: 19.7
* Neurosurgeons per 100,000 population: 2.6
* Orthopedists and hand surgeon specialists per 100,000 population: 12.7
* Plastic surgeons per 100,000 population: 3.3
Quality + Safety Environment Highlights
* Funding for quality improvement within the EMS system: No
* Funded state EMS medical director: Yes
* Emergency medicine residents per 1 million population: 33.1
* Adverse event reporting required: Yes
* Percent of counties with E-911 capability: 100%
Disaster Preparedness Highlights
* Per capita federal disaster preparedness funds: $6.54
* ESF-8 plan shared with all EMS and essential hospital personnel: Yes
* Emergency physician input into the state planning process: Yes
* Drills, exercises conducted with hospital personnel, equipment, facilities per hospital: 0.2
* Public health and emergency physician input during ESF-8 response: Yes
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