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‘Age Is Just a Number’ — Does It Hold True for EHR Adoption?

Older physicians are less likely to use an electronic health record system  than their younger counterparts. A recent Health Affairs study found that in 2011 30.8%  of physicians older than age 55 were using a basic EHR system, compared with 40%  of doctors younger than age 40 and 35.5% of doctors ages 40 to 55.

There are several reasons for the lower EHR adoption rates among older  physicians. Some older physicians might not be as technologically savvy as  younger doctors and thus are reluctant to transition to an electronic-based  workflow. In addition, older physicians are more likely to work in solo or small  practices, which face greater financial barriers to EHR adoption. Further, some  older physicians say they’ll be ready for retirement by the time they start to  see any return on investment from EHR adoption.

Currently, older physicians who use a paper-based record system are not  eligible for Medicare and Medicaid incentive payments under the meaningful use  program. And, beginning in 2015, physicians who cannot demonstrate meaningful  use of EHRs will be subject to a 1% reduction in Medicare payments. That penalty  will increase by 1% in each subsequent year, eventually reaching 5%.

Push for a Hardship Exemption for Older Physicians

Arguing that older physicians face unique barriers when it comes to EHR  adoption, some groups are pushing for CMS to include a hardship exemption  category in the meaningful use program for doctors who are close to  retirement.

In its comment letter to CMS on the proposed rule for Stage 2 of the meaningful use program, the  American Medical Association called for an exemption for physicians who  currently are eligible or will be eligible by 2014 for Social Security  benefits.

AMA wrote, “It would be economically burdensome for physicians who intend to  retire in the next several years to purchase, install and meaningfully use an  EHR.” It added, “We are also concerned that many of these physicians may decide  to close their Medicare fee-for-service panels or opt out of Medicare to avoid  penalties during the end stage of their clinical careers, which would adversely  affect access to care for our nation’s elderly and disabled.”

An AMA policy expert said that EHR adoption is a significant investment both  in terms of cost and time and that older doctors likely won’t be practicing long  enough to realize the benefits of health IT, such as improved patient care and  efficiency.

She said that if a physician plans to retire within five years, it probably  doesn’t make financial sense to invest in an EHR system.

Without a meaningful use exemption for older physicians, such doctors could  close their practices prematurely or limit the number of Medicare beneficiaries  they treat, according to the AMA policy expert.

Rep. Renee Ellmers (R-N.C.) — chair of the House Small Business Committee’s  health care subcommittee — voiced similar concerns in a letter to CMS acting  Administrator Marilyn Tavenner.

Ellmers — who worked as a nurse for nearly 20 years — wrote, “I believe  that modern, well-equipped offices are vital to the practice of medicine, and  that health information technology can help all health professionals to improve  the delivery of care.” However, she said that she believes the goals in the  proposed Stage 2 rule “may be too ambitious” for physicians nearing retirement  age, as well as those in solo or small practices.

Ellmers urged CMS to allow hardship exemptions for physicians who are nearing  retirement — those who are older than age 60 — and for physicians in practices  with five or fewer physicians.

EHR Adoption Still Worthwhile for Some Older Doctors

A CMS policy expert acknowledged that there is a generational divide when it  comes to EHR adoption and that older doctors typically are more reluctant to  make the transition to health IT.

However, he said that CMS has been very encouraged by the number of doctors  in the older age brackets who are adopting EHRs and attesting for meaningful  use.

Reavis Eubanks — a solo-practice physician in western North Carolina —  adopted an EHR system in January 2011, at the age of 64.  He attested to  meaningful use Stage 1 in June 2011 and received $18,000 in incentive payments.

Eubanks said ignorance was the main thing that prevented him from adopting an  EHR system earlier in his career. He said, “I really did not realize that it  could be done affordably, and I did not realize the vast advantages that it  would give me as far as efficiency and communication.” Eubanks said, “If I knew  what I know now, I would have done it a lot earlier.”

Eubanks said his experience using a server-based EHR system at a hospital in  his area gave him “insight into the some of the problems that could arise if  [he] had his own in-house system.” As a result, Eubanks selected a cloud-based  EHR system from athenahealth.

One of the reasons Eubanks was attracted to athenahealth’s product is that  the vendor offered a guarantee to meet Stage 1 meaningful use certification  criteria. Another big selling point was the significantly lower upfront cost.

He said, “You can adopt a cloud-based system at a much, much [lower] upfront  cost. The thing that always comes up is, ‘Yes, but you’re having to pay that  percentage [fee] every month.’ But my retort to that is, ‘Yes, but you’re  getting better and better services every month because the subscription-based  company is not going to make any money unless the physician is making money.'”

Eubanks said EHR adoption “does have a learning curve and it does certainly  have the potential of fairly adversely affecting the workflow,” but “it doesn’t  have to be that way.”

He said it is important that the physician doesn’t “feel constrained to have  to do it like the system tells him to do it, rather than the system being his  servant and helping him accomplish things.” Eubanks also said he made great  efforts to ensure that his new EHR system did not detract from his interactions  with patients.

As a result of adopting an EHR system, Eubanks said he has seen significant  improvements in claims processing, documentation and communication.

Eubanks said he would encourage older physicians who are on the fence about  EHRs “to adopt electronic records even if they weren’t interested in meaningful  use because of the benefits … particularly communication with other people,  good documentation and the fact that when somebody gets your record, they can  actually read it.” In fact, Eubanks said he would have adopted an EHR system  even without the promise of meaningful use incentive payments.

Still, Eubanks sees a lot of value in the meaningful use program. He said the  program “has asked us to do things that I believe any good physician should have  been doing all along.” He added, “And therefore even outside of return on  investment, the criteria for meaningful use would be beneficial to anybody  that’s interested in providing good medical care.”

The CMS policy expert said that the meaningful use is about improving patient  care through better care coordination, reducing unnecessary procedures and  boosting patient safety. He said that doctors of all ages understand how  important better patient care is.

Eubanks said he does not believe there should be a meaningful use program  exemption for doctors who are close to retirement age, noting that such a  statement is “unusual for a very conservative individual to say as far as a  government mandate.” He said he believes the meaningful use program is trying to  provide “good medical care … so therefore, I don’t think there should be an  exemption.”

Likelihood of a Hardship Exemption for Older Doctors?

In its proposed rule for Stage 2 of meaningful use, CMS asked stakeholders to  weigh in on proposed hardship exemptions, as well as offer other exemption  categories that they believe should be added.

Because CMS is in a period of rulemaking, the agency could not comment on the  likelihood of the inclusion of a hardship exemption for physicians close to  retirement in the final rule.

An AMA policy expert said AMA believes its recommendation for such an  exemption is reasonable and noted that CMS listened to some of the group’s  feedback on Stage 1 of the program.

However, she said that AMA made similar hardship recommendations for CMS’  electronic prescribing incentive program that were not incorporated into the  final rule.

Still, the AMA policy expert said there’s more at stake financially with the  meaningful use program. She noted that EHR systems are significantly more  expensive than stand-alone e-prescribing systems; the meaningful use program is  long-lasting, while the e-prescribing incentive program ends in 2014; and the  meaningful use penalties are more substantive than those in the e-prescribing  program.

CMS plans to release its final rule for Stage 2 of the meaningful use program  and detail the final exemption categories in late summer.

Source: iHealthBeat

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