HITECH Act entices physicians into future with incentives

By Jill Coley

The federal government has put aside nearly $20 billion to convince doctors to ditch their manila files for electronic medical records. But look at any physician’s walls of patient records, and the enormousness of that task becomes apparent.

In the Lowcountry, opinions are mixed. Most agree the move would reduce unnecessary testing, administrative overhead and medical errors. Yet with so many systems to choose from, patient privacy concerns and the time it takes to learn new software, money might not be enough.

Dr. Christos Maltezos, a Mount Pleasant endodontist, is ahead of the curve and already paperless. “That’s where the future is going,” he said. Patients can fill out forms at home and enter their medical and pain histories online.

In addition to streamlining administrative work, going digital also reduces forgery since doctors can send prescriptions to pharmacies digitally, said Maltezos, who can access patients’ records on his BlackBerry no matter where he is. “I don’t think I could do it any other way now,” he said.

Starting out digital is easier than changing over. The older internist may imagine scanning in 300-page medical records. But after a few patient visits, most of the information would be contained in an electronic file.

The Health Information Technology for Economic and Clinical Health Act, or HITECH, became federal law in February and created payment incentives in Medicare and Medicaid to encourage providers to go digital. It wasn’t long before electronic medical record vendors began using the promise of stimulus money to entice physicians.

Chris Hughes, founder of Advanced TeleHealth in Mount Pleasant, consults physicians before they adopt an electronic medical records system to make sure their practice is ready for the technological leap and is compliant with the Health Insurance Portability and Accountability Act, or HIPAA.

The economics of the situation is going to drive electronic medical records forward, Hughes said.

Dr. Dave Albenberg is passionate about electronic medical records but worries the government’s lofty goal may not be feasible.

Albenberg invested about $150,000 in a digital system for his concierge practice, Access Healthcare, in Charleston and Mount Pleasant.

Every doctor thinks it needs to be done differently, and getting all of them on the same platform is impossible, Albenberg said. “This is something you can’t throw money at,” he said.

Dave Terry, former administrator of James Island Medical Care, knows firsthand the pitfalls of electronic medical records. The 6,000-patient practice tried to go electronic about six years ago, and although hardware and software has improved since, the experience is still fresh in his mind.

Doctors use so many categories of codes, Terry said, that when physicians got in a room with a patient, the program went “six ways to Sunday.”

“You feel quite often like a deer in headlights in the middle of a patient encounter,” he said. Training was a problem because doctors couldn’t stop seeing patients long enough to learn the system. And if a staff member was sick or on vacation, their replacement had to be schooled in the software.

“We yanked it out and went back to paper,” Terry said.

Above article published on http://www.postandcourier.com/news/2009/may/04/doctors_look_into_digital_age80979/

The recently adopted package increases support for research into the best treatments for the same medical conditions or illnesses.

By Doug Trapp, AMNews staff.

Washington – A conservative backlash against comparative effectiveness research provisions in the stimulus package could be the first sign of a difficult health reform debate to come.

The stimulus act enacted Feb. 17 provides $1.1 billion to federal agencies for evaluations of the effectiveness of different drugs, devices and procedures on the same medical condition. The infusion is a huge increase over existing funding for comparative effectiveness research.

But the provision attracted unwanted attention as the stimulus bill moved forward. The House Appropriations Committee’s summary of the version it approved on Jan. 15 said the bill would help determine which drugs, procedures and medical interventions are “less effective and in some cases, more expensive.” Mentioning cost savings as a potential benefit of the research language was enough to lead conservative media outlets, from the Washington Times to radio host Rush Limbaugh, to conclude that an era of government-rationed health care was coming.

The speculation also was fueled by bill language creating a panel of federal government leaders to recommend federal priorities for comparative effectiveness research. A November 2008 white paper by Sen. Max Baucus (D, Mont.), chair of the Senate Finance Committee, cited a Congressional Budget Office estimate that $700 billion of the nation’s annual $2.3 trillion health spending is ineffective, said Dennis Smith, former director of the Centers for Medicare & Medicaid Services’ Center for Medicaid and State Operations and a senior fellow at the Heritage Foundation.

Some GOP members of Congress, including Sen. Mike Enzi (R, Wyo.), spoke out against what was seen as a potential for additional government power over health spending. “The bureaucracy, not doctors and patients, will have the power to make decisions about which treatments folks can and can’t have,” Enzi said Feb. 13.

Robert Doherty, the American College of Physicians’ senior vice president for governmental affairs and public policy, said some conservatives were looking far into the future when they objected to the act’s research provisions. “This was viewed by some as the opening skirmish in a broader battle over the role of government in health care,” Doherty said. The ACP and the American Medical Association supported the comparative effectiveness provisions and funding in the stimulus package, called the American Recovery and Reinvestment Act of 2009.

The final version of the bill did not specifically include cost as part of comparative effectiveness research. The House Appropriations panel’s report summarizing the House-Senate negotiations that produced the final version said the research funding “is not to be used to mandate coverage, reimbursement or other policies for any public or private payer.”

“There are a lot of dots [conservatives] are connecting. And the dots are certainly not connected in the bill,” Doherty said.

Adding “clinical” to “comparative effectiveness” in the bill’s language would have clarified that the research won’t include costs as a factor, but the stimulus act didn’t do that, said Gail Wilensky, PhD, a former Medicare administrator and senior fellow at Project Hope, an international health advocacy organization. “That is, in my mind, a permissive difference,” she said.

Smith agreed on the need to compare treatments, but he worries about any payer, especially Medicare and Medicaid, having too much influence in the medical payment system.

Doherty said the concerns about government intrusion are overblown. “All it really does is provide additional funding to the National Institutes of Health and the Agency for Healthcare Research and Quality to build upon their existing work they are doing in comparative effectiveness.”

Doctors and patients need more rigorous evidence about treatments’ effectiveness, Doherty said. Informed patients might be more likely to choose a less-invasive treatment if its outcome is similar to surgery or another more invasive option.

Government funding of research isn’t a perfect solution, said Roy Poses, MD, a clinical associate professor of internal medicine at Brown University in Rhode Island who has researched clinical epidemiology and evidence-based medicine. “But in the absence of research, the government might use something else to make coverage decisions that might be even less valid,” he said.

Doherty said several ACP members contacted him after the association said it supported the stimulus bill, which was controversial among conservatives for a variety of reasons. “So it was hard to separate the health care provisions from one’s overall views of the stimulus bill. For more conservative physicians … a lot of them didn’t like the idea of the stimulus bill, period.”

The print version of this content appeared in the March 16, 2009 issue of American Medical News.

Above article published on http://www.ama-assn.org/amednews/2009/03/09/gvsb0309.htm