Coming back to reality, unfortunately, mere sympathy does not incentivise me to continue providing the type of care I provide. It is obvious to me that in order for any type of P4P program to succeed, the process of data collection must be simplified and the collection of data must not be the responsibility of the physician – this takes away the physician’s focus from providing high quality care to documenting care and collecting data (as has happened with current PQRI process). As far as private insurers voluntarily offering incentives for EHR use, I can say for sure that its untrue in our area – SE PA. I know that for a fact because of my inquiries over the past 3 years with all major carriers in our area. They do not even like to mention this in any discussion. But I will check out the website further. It would serve everybody if Mr. Leavitt could provide evidence as to how CMS selected the “small practices” for its EMR study; because I am on its list-serve, and I was not offered such an option. It appears to me that only those connected to large university-based/affiliated groups got the opportunity. If this was the case, I am afraid, it is going to be a short-lived effort. I hope I am wrong, for a change.

I agree with “suehouck” who points out the gap between potential and reality in realizing EHR benefits. EHR software can and should get better, faster, and easier to use with time, and we also need more skilled implementation help. Also, we need all of our doctors and nurses to be using this technology during their training so the switchover won’t be so traumatic later. Some implementations still fail (which is certainly the case in her example of a 20% productivity drop a year after go-live), requiring re-examination of the whole picture: clinician leadership, adequate staff buy-in, workflow re-engineering, template and pick list set-up, etc.

“johnrgraham” went right to the ‘elephant in the room’ question: Why does the doctor not face the right incentives? I believe the answer is because our payment system rewards volume; not quality, safety, or cost-effectiveness. Bonuses for Health IT aren’t bribes, they are just small examples of correct incentives within a larger dysfunctional system.

I appreciate the dialog! Mark

For a third party to bribe a doctor to do something for which neither the doctor nor patient are willing to pay themselves, because the 3rd party believes it will improve health care, seems the height of fallacious central planning.

Steve Jobs and Apple has not developed an easy to use i-pod of EHRs, so learning curves are steep and useability a challenge with many sytems. A year after implementation, one client who’d put enormous resources into implementing a CCHIT certified system suffered from a 20% drop in physician productivity a year later.

One of the main obstacles to more IT adoptions by physicians stems from the unscruplous tactics adopted by most of the IT companies, and the absence of any standards regarding contractual obligations, reasonable charges for ongoing services, resolution of disputes without getting tied up with litigation, etc. Another major problem that we all face is complete lack of interest in collaboration from all other parties such as Surescripts, national laboratories, local hospitals, etc. Just like how small practices have no leverage with payers, similarly they have none with these organisations. Costs of interoperability should not be the physicians’. It is in the consumers’ (patients) interest that data be readily shared amongst various repositories. This is where governmental action will be beneficial.

Finally, CMS and all payers must learn that 1-2 % bonus payments are nothing but an insult to physicians, who honestly strive every day to provide the highest quality care to their patients. Even a plumber will return such a paltry bonus payment. Besides, looking to add CPT-II codes while trying to help an ill individual, is not a natural process (assuming one can understand and implement the convoluted PQRI process). Start looking at the big picture, Mr. Leavitt and play ball with the small players as well. Who knows, you might find a lot more stars amongst this group. Look forward to your response.