Even With Support Staff, Meaningful Use Is Still Too Much Work

April 01, 2011 04:20 pm Robert Collins, M.D.

Editor's Note: AAFP members are all over the map in terms of how they feel about the federal government's plan for health information technology, or health IT; electronic health records, or EHRs; and the meaningful use incentive program. Here is the opinion of one AAFP member.

[Robert Collins, M.D.]

Robert Collins, M.D.

We're on a meaningful use-certified EHR here at our university's health services, and we participate in Medicare for our retired staff members and their families. We already meet some of the meaningful use requirements, too. But are we going for the incentive money? The answer is no.

Don't get me wrong -- I'm fully in favor of the concept behind meaningful use. We need to get EHR technology out into the world. Although I joke that it was my handwriting that drove me to an EHR back in 1997, in truth, it was a quality issue. I would never want to go back to a paper or a dictated system.

But we aren't pursuing the meaningful use incentives because the return on investment is too small, given the number of Medicare patients we see.

I have a tremendous support staff that most FPs would envy, including a fully dedicated IT person and a medical records director. Yet it still would be too labor-intensive to provide all the reports that meaningful use criteria require. I can imagine how much more grueling it would be for FPs in small practices.

My biggest complaint with the government is its obsession with micromanagement at the patient encounter level. They should be looking at outliers -- people outside the bell-shaped curve -- but instead they want to scrutinize everything we do. It requires too much labor on the physician's part, even with an EHR. That physician still wants to go home and have a family life!

I doubt that practicing clinicians had much input into the design of meaningful use. It looks like it is the product of wonks who knew what they wanted to achieve but didn't have a clue about making it work for practicing physicians.

For example, the wonks developed a set of codes (Category II codes) to identify whether you've checked a patient with diabetes for hemoglobin A1c in the past year and what the level is (3044F through 3046F), but most EHRs can't implement these codes to have them recorded in the billing system. Someone -- frequently the care provider, the most expensive person -- has to link them into the billing charges, negating the time saved with the EHR.

Instead, why not have us report the percentage of patients with diabetes who have been checked for hemoglobin A1c in the past year? Our EHR could generate that report in a snap, no workaround required.

However, all of this may be a moot point. With the current budget crisis, I'm not sure the government will be able to force the hand on EHRs. Congress may take away the incentive funds.

Even if that happens, I hope Congress can create improvement in payment for primary care physicians, even with federal budget cutting. As things stand, the government is killing primary care.

I'm in my early sixties and will be around for a while, but no replacement will take my place if payment for primary care services continues to lag behind payment for procedures. That's where the medical students will continue to go, not to the thinking specialties.

Robert Collins, M.D.
Executive Director
University Health Services
Team physician
Mississippi State University
Mississippi State, Miss.


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