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The “Price” of eHRs

15 Responses

1. Darrell K. Pruitt DDS, on December 10, 2012 at 5:12 PM said:

   Earning stimulus money the hard way

   Want to know why participating in Meaningful Use requirements for stimulus money might not be worth the effort?
   

   Read “Watchdog call for EHR bonus audits meets resistance Medicare’s chief says adding more regulatory roadblocks could prevent physicians from adopting electronic health record systems by the time noncompliance penalties start in 2015,” by Charles Fiegl, amednews staff. It was posted today.

   http://www.ama-assn.org/amednews/2012/12/10/gvl11210.htm

   “Protecting taxpayer dollars is our top priority, and we have implemented aggressive procedures to hold providers accountable,” a CMS spokesman said.

   So how badly do you really want that stimulus money, Doc?

   Darrell K. Pruitt DDS

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2. Ann Miller RN MHA, on December 11, 2012 at 1:03 AM said:

   EHR incentive payments nearing $10 billion

   Darrell – Based on preliminary calculations through the end of November, the Centers for Medicare & Medicaid Services expects EHR Incentive Program payments to reach $10 billion by the end of 2012.

   http://www.physbiztech.com/news/ehr-incentive-payments-building-toward-10-billion-milestone?email=MARCINKOADVISORS@MSN.COM&GroupID=90115

   That figure reflects Medicare and Medicaid payments issued since the programs’ inception.

   Ann Miller RN MHA

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3. Darrell, on December 11, 2012 at 2:45 AM said:

   Meaningful Use is predictably costly

   In place of consumers ruling their healthcare in the US, well-positioned, giant stakeholders have persuaded lawmakers to offer physicians bonus money (that will later be taken away), not for curing patients, but for using digital records “in a meaningful manner.” It’s called Clicking for Cash. Since the rules are made up along the way, they change like the weather… I wrote that on April 10, 2009. As anyone can see, I told you so.

   Fred Schulte has been covering Meaningful Use and ARRA stimulus money since 2009 when he was hired by the Huffington Post to investigate the Obama administration’s plan to persuade doctors and hospitals to convert to EHRs by throwing taxpayers’ $30 billion up in the air.

   Less than two weeks ago, “Race to electronic health records may come with a price,” by Schulte was posted on the Association of Health Care Journalists (AHCJ) website.

   http://healthjournalism.org/resources-articles-details.php?id=249#.UMYdnINZVyQ

   Schulte introduces the investigation by describing a giddy, bi-partisan HIT-friendly atmosphere in the early days of the Obama administration when his top health care adviser, the former Democratic Sen. Tom Daschle, joined former Republican House Speaker Newt Gingrich in public forums promising that the conversion of healthcare from paper to digital will save lives and money. “It was about the only thing they could agree on.” As it turns out, they were bipartisan-wrong on both counts.

   Schulte adds, “But amid all the enthusiasm, politicians and policy makers paid little attention to the implications of a gold rush sparked when billions of taxpayers’ dollars suddenly came up for grabs. Hundreds of medical technology companies scrambled to sell digital systems — often by promising doctors and hospitals they could boost revenues by billing higher rates to Medicare and other health insurers.” The problem is, the medical technology companies delivered on their promises and the politicians didn’t.

   The 3-part investigative series by Schulte and David Donald is posted on The Center for Public Integrity website, and reveals that providers increasingly billed Medicare for more complex and costly health care over the past decade than previously, adding $11 billion or more to their fees, “despite little evidence that elderly patients required more treatment.”

   http://www.publicintegrity.org/health/medicare/cracking-codes

   “While it’s impossible to know precisely why doctors and hospitals moved to better-paying codes in recent years, it’s likely that the trend in part reflects ‘upcoding,’ — the practice of charging for more extensive and costly services than delivered, according to Medicare experts, analysis of the data and a review of government audits.

   And Medicare regulators worry that the coding levels may be accelerating in part because of increased use of electronic health records, which make it easy to create detailed patient files with just a few mouse clicks.” (Clicking for cash).

   Schulte concludes the AHCJ article: “It’s hard to say at this point whether the strong political support for electronic health records will erode. But as officials struggle to slash soaring Medicare costs, the program may face new pressure to demonstrate it can achieve its goals. That seems fair enough.”

   Perhaps ADA President Dr. Robert Faiella should reconsider his recent support for Meaningful Use requirements in dentistry. What do you think?

   Darrell

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4. Dr. Carter, on January 15, 2013 at 4:08 PM said:

   Are providers ripe for a massive medical records heist?

   http://www.govhealthit.com/news/not-merely-lost-what-happens-stolen-health-records?topic=18

   Stolen health records are worth five orders of magnitude more than financial ones — and as mobile devices, electronic information exchange, and healthcare cloud repositories proliferate across an industry lagging in encryption practices, those health records might become more alluring to organized criminals.

   http://www.govhealthit.com/news/are-providers-ripe-massive-medical-records-heist?topic=08,12,,18

   Dr. Carter

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5. Ann Miller RN MHA, on January 18, 2013 at 11:00 AM said:

   Fix Too Late for Some Docs to get Full EHR Pay

   The CMS will fix a systems glitch and allow physicians and other professionals working with critical-access hospitals to participate in the federal electronic health-record incentive payment program, but apparently not in time for these EHR users to get paid top dollar under the Medicare portion of the program, according to an agency announcement.

   A CMS fact sheet on the agency’s website says “due to the time required to implement system changes,” it won’t accept attestations from critical-access hospitals on behalf of these physicians and other professionals until January 2014.

   Source: Joseph Conn, Modern Healthcare [1/17/13]

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6. Darrell K. Pruitt DDS, on March 6, 2013 at 2:16 AM said:

   Let’s discourage dishonesty

   If EHRs are not saving physicians money as promised – even with 21 billion dollars of taxpayer help – why should dentistry tolerate dishonesty from its stakeholders, Doc?

   “Doctors to Lose Money on Electronic Records, Survey Finds” by Alex Nussbaum was posted on Bloomberg yesterday.

   http://www.bloomberg.com/news/2013-03-04/doctors-to-lose-money-on-electronic-records-survey-finds.html

   “Most doctors who install electronic medical records systems will lose money in the first five years, according to a study that suggests a multibillion-dollar effort to computerize care in the U.S. may not live up to its promise.”

   Darrell K. Pruitt DDS

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7. Darrell K. Pruitt DDS, on March 20, 2013 at 2:38 PM said:

   Past-Perfect EDRs?

   “Boulder Community Hospital computer system crash frustrates patients – Officials say it could take until Friday for outage to be resolved.”

   http://www.dailycamera.com/news/boulder/ci_22819319/boulder-community-hospital-computer-system-crash-frustrates-patients.html

   The hospital community could learn something from dental practices. One never hears of dentists’ computers crashing. In fact, since one doesn’t hear anything at all about the faults of electronic dental records, I think we can assume they are perfect.

   Darrell K. Pruitt DDS

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8. Ann Miller RN MHA, on April 12, 2013 at 11:46 PM said:

   Proposed Rules Would Extend EHR Safe Harbor

   The CMS and HHS’ inspector general’s office have issued a pair of complementary proposed rules to extend 2006 waivers that relaxed federal Stark and anti-kickback laws to promote the use of electronic health-record systems. The proposed rules would extend the Dec. 31, 2013 sunset provisions in the original rules to Dec. 31, 2016. They also would drop an e-prescribing requirement in the original rules and amend language on what types of EHRs qualify for the waivers.

   In the updates, rulemakers propose revisions in the deeming language for interoperability, substituting that a certification body must be “authorized by” the ONC instead. They also added a two-year regulatory interval instead of 12 months.

   Source: Joseph Conn, Modern Healthcare [4/9/13]

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9. Darrell K. Pruitt DDS, on June 22, 2013 at 12:13 PM said:

   Optometry Too!

   “Optometry EHR Breached in Florida, 9,000 Notified.”
   An essay by Joseph Goedert.

   http://www.healthdatamanagement.com/news/breach-notification-hipaa-privacy-security-46299-1.html

   Of the 9000 Sight and Sun Eyeworks patients in Florida who have been notified that their identities were fumbled, how many do you think are pissed off enough to find a new optometrist?

   Darrell K. Pruitt DDS

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10. D. Kellus Pruitt DDS, on July 12, 2013 at 10:42 PM said:

    Expensive EHRs

    HHS intends to make examples of those who fumble patients’ identities, and has offered to share revenue from fines with patients who turn in their doctors for HIPAA violations. Patriotic greed can be very expensive.

    “WellPoint pays HHS $1.7 million for leaving information accessible over Internet” No byline, Fort Mills Times, July 11, 2013.

    http://www.fortmilltimes.com/2013/07/11/2816271/wellpoint-pays-hhs-17-million.html

    “Whether systems upgrades are conducted by covered entities or their business associates, HHS expects organizations to have in place reasonable and appropriate technical, administrative and physical safeguards to protect the confidentiality, integrity and availability of electronic protected health information – especially information that is accessible over the Internet.”

    Fort Mills Times continues: “Individuals who believe that a covered entity has violated their (or someone else’s) health information privacy rights or committed another violation of the HIPAA Privacy or Security Rule may file a complaint with OCR at: http://www.hhs.gov/ocr/privacy/hipaa/complaints/index.html.”

    A doctor’s fine becomes a patient’s award: “HIPAA Enforcement: Distribution of a Percentage of Civil Money Penalties or Monetary Settlements to Harmed Individuals”

    http://www.reginfo.gov/public/do/eAgendaViewRule?pubId=201210&RIN=0945-AA04

    Abstract: This advance notice of proposed rulemaking would begin to establish a methodology under which an individual who is harmed by an offense punishable under HIPAA may receive a percentage of any civil money penalty or monetary settlement collected with respect to the offense, as required by section 13410(c)(3) of the Health Information Technology for Economic and Clinical Health Act (title XIII of the American Recovery and Reinvestment Act of 2009). The Department plans to publish an advance notice of proposed rulemaking to solicit the public’s views on establishing such a methodology.

    This is nuts.

    D. Kellus Pruitt DDS

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11. Ann Miller RN MHA, on December 25, 2013 at 2:14 PM said:

    Taking the EHR Penalty
    [More Doc Offices May Opt Out]

    Despite the federal government giving extra time to healthcare providers to stay at the next stage of electronic health record meaningful use, health information technology leaders worry that the number of physician offices opting to bag the whole program will continue to grow.

    The concern comes from two fronts: cost and clinical.

    The penalties for failing to meet Stage 2 of the meaningful-use requirements that were attached to taking federal incentive payments for adopting EHRs are minimal.

    Moreover, most of the incentive payment money was linked to achieving Stage 1 meaningful use, which, for a majority of providers, is already in the rearview mirror. There’s not much financial upside from continuing to participate in the program.

    Source: Joseph Conn, Modern Healthcare [12/21/13]

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12. Darrell Pruitt, on August 16, 2014 at 6:49 PM said:

    Providers’ cost

    “Electronic prescription services cost my practice $600 per provider every year. The estimated cost for even a small medical practice to institute electronic health records is as high as $80,000 and includes only the computer hardware and software. That doesn’t include annual maintenance and upgrades.

    The federal government set up an incentive program to help providers defray the cost of electronic health records, but the rules are so cumbersome that many practices are being forced to return incentive funds they received after undergoing audits.”

    Thomas R. Cheezum OD
    (See: “The Providers’ costs,” Hamptomroads.com, August 16, 2014).
    http://hamptonroads.com/2014/08/providers-costs

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13. D. Kellus Pruitt DDS, on November 13, 2014 at 5:46 AM said:

    The costs of EHRs increase, while the cost of paper has been stable for decades

    “Conn. Supreme Court HIPAA Decision Likely to Spawn More Litigation – In a first-of-its-kind decision in the state, the Connecticut Supreme Court has ruled that patients can bring negligence lawsuits against health care providers violate federal privacy regulations.” By Jay Stapleton, The Connecticut Law Tribune, November 11, 2014

    http://www.ctlawtribune.com/id=1202676138225/Conn-Supreme-Court-HIPAA-Decision-Likely-to-Spawn-More-Litigation#ixzz3It5exvYp

    “In its unanimous Nov. 4 decision authored by Justice Flemming Norcott Jr., the court determine that ‘neither HIPAA nor its implementing regulations were intended to preempt tort actions under state law arising out of the unauthorized release of the plaintiffs medical records.’”

    So will the popular trend of punishing providers make electronic dental records even more expensive than paper? You bet.

    D. Kellus Pruitt DDS

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14. D. Kellus Pruitt DDS, on January 6, 2015 at 5:42 PM said:

    Even I know that the mortal danger of medical identity theft is nothing new
    [EHRs and mortal danger]

    “For instance, a man goes into to a hospital to get treated for a back injury. Upon being X-rayed the doctor also notices that the man has a swollen lymph node, for which he prescribes penicillin. The man says he’s allergic to penicillin. The doctor asks, then why did you come into this hospital a week ago for penicillin? The man says, I didn’t come into the hospital a week ago for penicillin … you get the drift. Now imagine that same scenario except the patient is unconscious and his/her record has been altered to remove the reference to his penicillin allergy. Now we’re talking about a scenario where the patient’s life is potentially in danger” – Ruth Reader, “Data suggests we should be more worried about medical breaches,” VentureBeat News, January 5, 2015.

    Data suggests we should be more worried about medical breaches

    8 years ago

    “The [stolen] EHR and insurance coverage that the patient bought for $200 said that the previous owner was diabetic. No problem. The record is digital. Diagnoses and treatments can be changed along with medication allergies. Do you see where this leads? If an unconscious person is admitted to an emergency room, contaminated electronic medical records could quickly kill the patient, and nobody would know why” – Darrell K. Pruitt DDS, “Careful with that electronic health record, Mr. Leavitt,” WTN News, October 18, 2006.

    http://wtnnews.com/articles/3407/

    Not wrong. Just early.

    D. Kellus Pruitt DDS

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15. D. Kellus Pruitt DDS, on July 25, 2017 at 6:50 PM said:

    Is the future of electronic dental records guaranteed, no matter what?

    “Physician practices bemoan skyrocketing cost of IT maintenance – MGMA survey shows some spending $19,000 per doctor, per year.”

    Mike Miliard for HealthcareIT News
    July 24, 2017.

    http://www.healthcareitnews.com/news/physician-practices-bemoan-skyrocketing-cost-it-maintenance

    What if dental EHRs are not only costlier than paper dental records, but are also more dangerous for providers and patients? And to top it off, what if electronic dental records offer patients not one benefit worth mentioning in dentists’ advertisements?

    What if Americans were properly warned?

    D. Kellus Pruitt DDS

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