Electronic Health Record System Down – Observations

EHROn Monday March 30, 2015 our Greenway Prime Suite electronic health record had a system wide failure at the level of the Edgemed Computer service center in New York State. It meant that I was back to using pencil and paper to interview patients and record the answers and physical findings. With much trepidation I began seeing patients with two sheets of white blank paper on a clipboard and my trusty BIC pen. To my surprise the sessions went by with ease. I was able to make much better eye contact with my patients, listen a bit closer and jot down the pertinent positive and negatives of the session to later enter into the computer record. My office visits are scheduled for 45 minutes each for routine follow up sessions and you need every second to be comprehensive and thorough and to check all the boxes and requirements imposed by government bureaucrats to comply with Meaningful Use and PQRS and Core Measure requirements. I found that without the computer it took at least ten minutes less time to see a patient and the visit was far more personal than with the magic box working.

Computerization was forced on physicians by the ARRA 2008 Congressional Law proposed and encouraged by the Bush administration to stimulate the economy and orchestrated further by the Obama Administration. Government grants and funds were set aside to computerize medical records, make the records more transparent and have data freely transmittable and reviewable from one system to the next. ARRA 2008 created a high tech committee which was funded at an extraordinary high salary level and staffed with the CEO’s and chief executives of the major health software manufacturing firms. If this sounds like asking the foxes to guard the hen houses you are beginning to get the picture. Their greed and self-serving interests led to multiple companies, with multiple products for sale most not designed or reviewed by practicing clinicians. Initially they were unable to communicate with any other competing systems and for the most part they still cannot. Interestingly when the 2014 Congress failed to refund the grants to the high tech committee this past session the CEO’s who ran it all resigned leaving the program rudderless.

The doctors and hospitals were promised a carrot at the end of the stick if you followed the ever changing rules but there was a financial penalty and reduction in reimbursement if you did not comply. The financial reward at the end of the stick in no way compensated an office for the work and trouble involved and was nowhere near the level of rewards the CEO’s who staffed the high tech committee actually received.

The computer software was supposed to be transparent and talking to each other by 2015. If this happens by 2020 it will be a true miracle. Yes the computer software corrects for illegible handwriting but not much else. Its costly, time consuming, expensive to maintain and it’s still difficult with the generic templates being used to determine if the patient the note is talking about looks like Haystacks Calhoun or Twiggy.

The system glitch was over by 4:00 p.m. that day and it took me about 3 hours to enter the patient visits into the system. My wife wondered why my “staff” couldn’t enter the data, but the vendors have not trained them for that function. So on Tuesday March 31, it is back to touch typing and computerized records so that the next President of the United States at his State of the Union Address can brag about how computers have brought down the rate of growth of spending on health care.

Why You Can Not Find a Physician Who Accepts Medicare

CMSSGR (sustained growth rate) is a policy and law put in place by the U.S. Congress signed into law four Presidential administrations ago and kept in place year after year by our non-creative elected Federal officials. It was designed to keep the costs of health care growth down by reducing payments to providers if they exceeded the health spending budget for the previous fiscal year. The problem is that health care spending has climbed continuously and it has never stayed within the budgetary guidelines legislated by Congress.

After the first year of the law the General Accounting Office noted an 8% increase in health care spending above the budgeted amount. Congress was supposed to reduce health care payments to providers by 8% the next year, but the providers howled about an 8% reduction and the President and the Congress backed down. Instead of a reduction they gave providers a cost of living increase. The GAO showed that the increased spending was not due to physician pay increases or physician generated costs but due to increased usage and expense in areas outside provider control. Every subsequent year since the SGR became law, the Congress has backed down and granted a miniscule increase instead. The difference between what was budgeted and what was actually spent has accumulated from year to year and each subsequent Presidential administration and U.S. Congress has been reluctant to correct the SGR because the monetary difference would appear on their administration’s balance sheet and legacy. That continued until the Affordable Health Care Act (Obama Care) passed and signed into law before anyone who voted on it actually read it, made correcting the SGR part of the law.

On January 1, 2013 the SGR was due to be repealed by Congress and health care providers were due to receive an 18%- 45% reduction in fees for services. Congress kicked the can down the block until January 1, 2014 and again until December 31, 2014 when Obama Care made the reduction mandatory. The last Congress kicked the issue down the road until April 15, 2015. They were supposed to settle the issue before their spring recess but they adjourned for the spring recess with promises of passing new legislation upon their return on Monday April 13, 2015. That was yesterday when Conservative Republicans announced that after two weeks of consideration they had major problems with provisions of the legislation they had agreed to pass before their spring recess. Their delay will go beyond April 15th.

The Centers for Medicare Services or CMS decided simply to not process any bills or make any payments to health care providers until Congress makes up its mind. Since April 1st they have paid no one except themselves. If no legislation is agreed upon by midnight tonight, CMS will begin processing payments to providers retroactively to April 1, 2015 with a minimum 21% reduction in fees compared to the 2014 payment rates. Physicians are reacting just as expected. Many have decided to no longer see Medicare patients. Those that do see Medicare patients will require payment for services by cash or credit card at the time of service with payments up to 115% of the 2014 Medicare allowable rate for that service. Many will leave the Medicare system entirely.

Our office will continue to see Medicare patients at the current time under the existing payment systems and we will give this Congress an opportunity to fix the problem. When we refer you to specialty physicians we have no way of knowing who will be seeing Medicare patients and who will not. We suggest you ask that particular office before your planned visit so there are no surprises at the check in check out window.