The incentives in the economic recovery act to encourage the conversion from paper to electronic health records could mean hundreds of millions of dollars for the state’s health care systems and doctors.

The emergency spending bill also could spur the final push needed to make paper charts a medical artifact.

“It’s going to drastically increase adoption,” said Michael Repka, executive director of the Independent Physicians Network, which negotiates contracts and provides other services for physicians in the Milwaukee area.

The long-awaited transition from paper to electronic records is considered essential if doctors and hospitals are to improve coordination of care, manage patients with chronic disease, lessen the wide variation in how medicine is practiced and monitor quality.

Electronic health records also will be a crucial component in any effort to link what doctors and hospitals are paid to the quality of care they provide instead of how many tests they order or procedures they perform.

The transition from paper to electronic health records is well under way in Wisconsin. The $19.2&enspbillion in incentives in the recovery act also will cover only a fraction of what health care systems are spending on health information systems. Froedtert & Community Health, for example, estimates its system will cost more than $70&enspmillion.

But the Wisconsin Hospital Association estimates the state’s large and midsize hospitals could receive $250&enspmillion – roughly $3&enspmillion to $4&enspmillion each – in incentives, starting in 2011.

“That’s a good chunk of money,” said Steve Brenton, the hospital association’s president.

The roughly 60 rural hospitals with fewer than 25 beds in Wisconsin could receive as much as $500,000 each under the spending bill, based on the hospital association’s estimates.

The incentives come at a time when health care systems are cutting back on capital projects because of huge losses incurred in their investment portfolios from the stock market collapse and because of flat or declining revenue as the economy buckles.

“Overall, this is extremely positive,” Brenton said. “It’s good for Wisconsin.”

The health care systems also will benefit from the incentives aimed at physician offices.

Under the spending bill, health care systems and physician practices can receive up to $44,000 for each doctor, nurse practitioner or other clinicians.

“It should spur physicians to do what they need to do,” said Repka of the Independent Physicians Network.

Nationally, only 4% of doctors’ offices had a fully functional system for electronic health records, while 13% had a basic system, with a minimum set of functions, according to a study published in June in the New England Journal of Medicine. An additional 16% of physician practices had bought a system but had yet to install it, and 26% said their practice was planning to buy a system in the next two years.
Money to speed change

The incentives in the American Recovery and Reinvestment Act are expected to quicken the pace.

“There finally is money on the table that is real money,” said Steven Waldren, a physician and director of the American Academy of Family Physicians’ Center for Health Information Technology.

Up to now, hospitals and doctors have borne the cost of converting to electronic health records while any savings from improving the quality of care, such as fewer medication errors, have gone to health insurers.

The incentives starting in 2011 will come through higher payments based on a complicated formula tied to Medicare or Medicaid.
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THE PRESIDENT: To Sir Edward Kennedy. (Applause.) That’s the kind of greeting a knight deserves. (Laughter.) It is thrilling to see you here, Teddy. We are so grateful for you taking the time to be here and the extraordinary work that your committee has already started to do, along with Mike Enzi; I know Max Baucus and Chuck Grassley on the Senate side; Henry, I know that you guys are gearing to go on the House side.

So I just want to, first of all, thank all of you for participating. Today was the first discussion in this effort, but it was not the last. In the coming days and weeks we’ll be convening a series of meetings with senior administration officials here at the White House to further explore some of the key issues that were raised today and to bring more voices into the conversation.

But my understanding is, is that we had an extraordinarily productive set of sessions throughout the day. And I’ve gotten a readout from some of the breakout groups and breakout sessions. And I just want to summarize a few things that my staff thought were notable and that I thought were notable and are worth mentioning before I start taking some questions or some comments.

First of all: A clear consensus that the need for health care reform is here and now. Senators Hatch, Enzi, Congressman Jim Cooper and many others agreed that we can do health care reform. Senator Hatch said that we needed leadership on both sides, and he believes that Democrats and Republicans need to put politics aside and work together to do it. Senator Whitehouse said this isn’t a “Harry and Louise” moment, it’s a “Thelma and Louise” moment. (Laughter.) We’re in the car headed toward the cliff and we must act.

Now, I just want to be clear — if you actually saw the movie, they did drive over the cliff. (Laughter.) So I just want to be clear that’s not our intention here. (Laughter.)

Insurers agree: Scott Serota with Blue Cross Blue Shield Association said to consider past opposition the past, it is not the present; the time is right for action now. The American Medical Association said that they are here to be partners and to help. Tom Donahue, with the Chamber of Commerce, said that in the previous debate we knew where everyone stood; people are in different places now, including business, and that there is a vigorous understanding with all parties that improvements are needed. And Congressman Joe Barton complimented the process we’ve begun and said that he can agree with the principles that we’ve laid out. My staff thought that was a very notable statement, they complimenting the process. Melody, I think, slipped that one in. (Laughter.)
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By Stephanie Desmon
Baltimore Sun
Legislators seek remedies before the situation gets even worse

When his longtime physician retired, Southern Maryland lawmaker Thomas “Mac” Middleton faced a predicament: The senator needed a new doctor but couldn’t find one who was taking new patients. “I had to go through three different doctor groups before someone would take me,” he said.

He ran right into the critical doctor shortage facing rural Maryland – to the west of Baltimore, to the south, on the Eastern Shore.

There are not enough primary-care doctors setting up practice in these areas, leaving some residents without access to basic health care and leading to more costly and serious illnesses, doctors say. Those doctors – and many specialists – are reluctant to leave the city for the country, where they typically get paid less, work more and find fewer job opportunities for their spouses, who aren’t always ready to give up the trappings of life near an urban area.

Middleton and other legislators in Annapolis are now seeking ways to recruit and retain physicians to care for people in large swaths of Maryland.

“We have areas where you just can’t get care – you have to leave and go to another jurisdiction,” said Gene Ransom III, executive director of the Maryland State Medical Society, or MedChi. “It’s a real problem for people, especially for people who can’t afford to do that.”

There used to be 10 obstetrician/gynecologists in Allegany County, for example; now there are four. There is just one psychiatrist in St. Mary’s County. The wait to see a new primary-care doctor on the Eastern Shore can be weeks – if that doctor is even seeing new patients.

Lawmakers – who worked on two task forces last year that looked at different parts of the issue – are considering both short- and long-term fixes. Solutions could include a loan forgiveness program for primary-care doctors and specialists in rural areas who agree to remain in those communities for a certain number of years. Newly qualified doctors come with as much as $200,000 in student loan debt, and earning enough to keep up with the payments can be difficult, especially in rural areas. (more…)

side note: At the end of the article, Tom Ockers, chief executive of Brookhaven Memorial Hospital Medical Center calls for the President to fund programs for preventive care and wellness. We at Doc Advocate also believe that there is a need to better educate physicians so they can help prevent frivolous lawsuits themselves. Check out Cunningham Group Insurance’s website to learn more about the book Healing Words on how a doctor can cut their number of claims by quite a huge amount.

BY RIDGELY OCHS
Newsday.com

Local hospital administrators applauded President Barack Obama for putting health care front and center in his budget proposal. But they said they need to see more details and worry that, given the dire state of the economy, the changes could be hard to implement.

“He’s addressing and raising the right kind of questions,” said Michael Dowling, chief executive of the North Shore- Long Island Jewish Health System, on Friday. “My only worry is that he’s bitten off more than he can chew.”

The budget proposal released last week calls for setting aside more than $630 billion over 10 years as a reserve fund to help pay for and expand health insurance – a move toward universal coverage. Half of the money would come from reducing Medicare and Medicaid payments made to hospitals, drug companies and insurance companies, and half by capping tax deductions for families earning more than $250,000 a year.

The president’s proposals include:

Eliminating subsidies to health insurers that sell Medicare Advantage plans, which are Medicare managed-care plans. Instead, the plans would be put under a competitive bidding process.

Requiring drug companies to give bigger discounts for drugs to Medicaid, which is health insurance for low-income people.

Cutting Medicare payments to hospitals that readmit a large number of patients within 30 days after they are discharged.

Linking a portion of Medicare payments to the quality of care delivered.

Reducing waste and fraud. (more…)