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ACP says Medicare should increase payments for physicians that use HIT to improve quality

(Washington) "The benefits of widespread adoption of interoperable Health Information Technology (HIT) will be significant, leading to a higher standard of quality in the U.S. healthcare system," Yul D. Ejnes, MD, FACP, told the House Ways and Means Committee subcommittee on Health today. "Unfortunately, without adequate financial incentives, small practices and their patients will be left behind the technological curve." Dr. Ejnes, a member of the Board of Regents of the American College of Physicians (ACP) and chairman of ACP's Medical Service Committee, testified at a subcommittee hearing, Promoting the Adoption and Use of Health Information Technology. "My 50-physician group practice has an electronic health record (EHR)," Dr. Ejnes, a general internist in private practice in Cranston, R.I., told the subcommittee as he cited personal experience. "Our practice leadership is tech-savvy, and we are fortunate to have received some support from a forward-looking private payer.

"With these favorable factors, you would think our decision to implement an EHR was simple. On the contrary, it took us 10 years. We have been using our EHR for two years now and have found that the challenges associatedespecially the cost and impact on workflow and the lack of true interoperabilityto be very substantial. Yet our challenges are not nearly as great as they are for physicians in smaller practices.

"Of the ACP members involved in direct patient care after training, approximately 20 percent are in solo practice and 50 percent are in practices of 5 or fewer physicians," Dr. Ejnes continued as he spoke from a more global perspective. "Three-fourths of all Medicare recipients receive their outpatient care from smaller physician practices. These are the physicians who already lag in HIT adoption and are least likely to have the necessary capital on-hand to invest in technology.

"Acquisition costs can average up to $44,000 per physician. The average annual ongoing costs are about $8,500 per physician. For many of these practices, the 'business case' for making such a large investment simply doesn't exist. Public and private payers -- not the physicians -- realize much of the savings from physician investment in acquiring the necessary HIT. Mandating use of HIT, especially in the absence of positive financial incentives and lack of uniform standards of interoperability and functionality, will likely drive the physician practices we need the most out of business. Positive incentives are the answer."

ACP specific recommendations to Congress included:

  • Build into the Medicare physician payment system an add-on code for office visits and other services when supported by certified HIT.
  • Continue to support the establishment of the standards needed to allow true interoperability.
  • Continue to advance the Patient Centered Medical Home, or PCMH, model as a means of rapidly driving primary care practices to acquire the information systems and other capabilities needed to provide patient-centered and coordinated care.
  • Require that Medicare cover specific services associated with patient-centered care, such as secure email consultations and remote monitoring.

"The College is the largest medical specialty society in the U.S., representing 126,000 internal medicine physicians and medical students," Dr. Ejnes concluded. "We share your optimism that health information technology can improve quality and decrease costs. Many studies have found that full adoption and utilization of HIT can improve quality and reduce high medical costs."


Contact: David Kinsman
American College of Physicians

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