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; electronic health records, or EHRs; and the meaningful use incentive program. Here is the opinion of one AAFP member.
Marie Steinmetz, M.D.
I practice with two other family physicians in an integrative medical practice that combines conventional and complementary therapies. I've had an EHR since 2006. But I won't get any government money for meaningful use because I don't participate in Medicare (or any other insurance, either).
I dropped out of Medicare six years ago because its payments did not cover overhead -- and because I refused to compromise the time I need to spend with a patient to provide the best medical care.
Amazingly enough, I still have lots of Medicare patients. They want to see someone who will spend time with them, and they like our integrative approach. We lose money on Medicare patients because Medicare rules don't allow us to bill them for their labs, and because I just couldn't charge them enough to cover our overhead.
To be honest, when meaningful use was announced, we thought, "Maybe we should start participating in Medicare again." We were already doing so much with our EHR that is considered meaningful use.
But I just couldn't bring myself to get back in. Although I think meaningful use isn't a bad thing, and our practice might be able to do it because we have a good EHR, the government has made it so complicated that some small practices might be destroyed by all the rules and regulations. We're already being paid so little by insurers and the government that many of us can hardly keep our doors open. Meaningful use is really another unfunded (or partly funded) mandate: more work and more money invested, all for a little bit of government money that doesn't make it worthwhile if you run the numbers.
Frankly, it was more than meaningful use that kept me from participating again. I hear about the audits where they look over everything you do. Most family physicians are very honest and try to do the best things for their patients, but those audits don't treat them that way. I want to take care of patients, not spend all my time reviewing charts for potential audits.
But I'll never want to do without an EHR. It's so much more efficient and effective than paper -- although it depends on how you use it. I've been seeing something with EHRs that bothers me greatly.
There's an epidemic of people lying -- perhaps unintentionally. For example, when a patient of mine goes to the emergency room with chest pain, the report sometimes says the ER did exams, including a neurological exam, but the patient says that the exam wasn't done. This happens because a template is embedded in the ER computer system that says they've done everything, and they haven't bothered to change the template. I even wonder if some doctors are copying notes from the last visit for a patient, word for word, without asking the patient if it's all still true.
I've talked to other doctors, and they're seeing this, too. That's the part about EHRs that no one is talking about -- garbage in, garbage out. I wish meaningful use could correct that!
Marie Steinmetz, M.D.
Group private practice