President Bush's Order Boosts EHRs, Price Transparency

An Aug. 22 executive order signed by President Bush will have little immediate impact on family physicians, unless they plan to buy or upgrade their electronic health records, or EHRs. Family physicians who are changing their EHR systems, however, should ask whether their vendors have already certified or are planning to certify their systems with the Certification Commission for Healthcare Information Technology, or CCHIT, according to Rosemarie Sweeney, AAFP vice president for practice management and policy analysis.

Official certification of an EHR is one of several criteria that family physicians should consider in purchasing and implementing health information technology in their practices, she said.

"If family physicians have an electronic health record that's not CCHIT-certified and they're going to upgrade, they need to ask their vendors whether the EHR system is currently certified or whether they're planning to get it certified," she said. "Many of these systems are so new that the vendors haven't had the opportunity to go through the certification process yet."

The executive order affects the Federal Employees Health Benefits Program, or FEHBP; Medicare; the Indian Health Service; the TRICARE program for the Department of Defense; and the health care program operated by the Department of Veterans Affairs. It calls on the agencies to

"In order to do business with the federal government, you've got to show us your prices, and you've got to help us develop a qualitative standard so the people that we're trying to help know what they're getting," said President Bush in remarks he made as he signed the order. "It's an order that basically commits the federal government to work with state and local (governments) and docs and hospitals to lead the way and be a part of this new movement about transparency in pricing and quality."

Physicians have expressed concern that government-mandated price transparency could mislead patients. AAFP President Larry Fields, M.D., of Ashland, Ky., expressed those concerns to Allan Hubbard, the president's assistant for economic policy, during a February White House meeting.

The concept "is a good idea, but must be done very cautiously," he said at the time. "A simple click of the mouse on the computer or a price list on the wall would be less than informative. It could lead to problems with expectations not being met on price."

The Academy has emphasized that health care differs from other commodities because the final price of an office visit often depends on the results of the history and physical examination. Although some prices, such as the charge for a basic office visit or an immunization, can be posted, a physician can't always predict the final cost of an acute care visit because additional lab work may be required to ensure an accurate diagnosis.

However, President' Bush's executive order doesn't mandate a price list above the office receptionist, according to Doreen Bell, AAFP government relations representative.

"What the order actually says is that each agency shall make available to beneficiaries the prices that its health plans pay to providers," she said. "There's nothing there that says it's necessary to provide that information prior to providing the services. Some people are wondering whether the current explanation-of-benefits letters sent to patients by insurers doesn't already cover that base. There's not much information on how to go about implementing it."

Analysts predicted no immediate impact on physicians caring for patients with Medicare, TRICARE, veteran's health services or FEHB. The order takes effect Jan. 1, 2007, but it addresses general goals that must be met over time, they say.

Although the executive order has little immediate pragmatic impact, its general sense supports AAFP efforts to encourage adoption of EHRs and to develop performance measures that improve patient care and lay the groundwork for future Medicare payment systems, according to Sweeney.

"This pushes the system in the direction that the Academy has been pushing," she said. "It promotes the idea of organized development and consistent use of performance measures, which we've been working toward through the Ambulatory Care Quality Alliance, the National Quality Forum and the Physicians' Consortium."

The Academy -- the first medical society to join the National Quality Forum and a founding member of the Ambulatory Care Quality Alliance -- has been recognized by government and industry officials for its leadership in development of quality measures.