Survey Measures Economic Stimulus Plan’s Effect on EHR
Adoption
An online survey of 1,888 physicians, medical group executives, and
staff released by Allscripts concludes that U.S. physician groups are
eager to accept a proposed multi-billion dollar package of government
loans, grants, and incentives designed to promote broader adoption of
information technologies such as the electronic health record (EHR).
The survey results reveal consensus among medical groups that funding
is critical, with 82% of respondents strongly agreeing that the government
should provide funding for EHRs via the HITECH Act, a key component
of the proposed $825 billion economic stimulus package now under consideration
in the U.S. Congress.
The survey also confirms that existing incentive programs managed by
the Centers for Medicare & Medicaid Services (CMS)—designed
to encourage hospitals to donate EHRs to physicians and to spur adoption
of e-prescribing—have been effective. But on several key issues
that are central to the debate underway in Congress, the survey reveals
a wide variance in opinions among respondents. This is especially true
when it comes to deciding what form of payment the government should
provide, whether funding should be targeted toward the purchase of an
EHR or incentives for use of an EHR.
As a result, the survey findings clearly suggest the most effective
route to achieving widespread EHR adoption lies not in a uniform approach
to all physicians but rather a blended model of incentives that address
the unique needs of different physicians in different types of medical
groups.
The goal of the survey was to gain insight into the perspectives and
preferences of healthcare professionals related to the current incentives
in place and the new proposed incentives for adoption and utilization
of EHRs, as well as privacy and security considerations. Key findings
included the following:
• Healthcare professionals support government incentives. Eighty-two
percent of respondents strongly agree that the government should provide
funding for EHRs via the HITECH Act.
• Current e-prescribing incentives are working. Seventy-five percent
of respondents to the survey are aware of the current e-prescribing
incentives from the CMS, and 37% are actively participating in the program.
• Current EHR subsidies provided by hospitals are effective. More
than 10% of practices surveyed have already received an offer from a
hospital to help subsidize the cost of an EHR for their group under
the Stark Safe Harbor exception. The 2008 CCHIT Incentive Index identified
50 programs nationally involving 115 hospitals that are currently providing
funding for physicians. Taken together with the Allscripts survey, this
data provide an indication that the current program has gained traction
in the market. However the new programs under consideration have the
potential to greatly more significant adoption.
• The proposed incentives may drive significant new adoption.
Sixty-eight percent of respondents would be likely to participate in
the pay-for-purchase proposal under consideration in the stimulus bill,
which provides sliding scale financial incentives resulting in payments
of up to $40,000 per provider over five years as reimbursement for the
purchase of an EHR. Only 2% of respondents indicated they would not
participate in this program, with the remainder either unsure (25%)
or unlikely to participate (3%).
• Groups without an EHR have equal preference for either a pay-for-purchase
or pay-for-use. Respondents from medical groups that do not have an
EHR expressed an equal preference for either a pay-for-purchase or pay-for-use
approach. Among all groups surveyed, preference for pay-for-purchase
decreased in direct correlation with practice size: 47% of respondents
from groups with between one and three physicians preferred to be reimbursed
for purchasing an EHR rather than provided incentives for its use; 32%
of those from groups with between four and 25 physicians agreed; 20%
of those from groups with 26 to 100 physicians agreed; and just 18%
of respondents from groups of 100 or more physicians agreed, with the
larger groups strongly favoring utilization incentives.
• Providers are confident in existing privacy and security protections.
Sixty-one percent of respondents from groups with an EHR say they want
to move forward without waiting for new privacy standards, expressing
confidence in their EHR’s existing privacy protections. The results
suggest that, while privacy breach will always be a concern, experienced
EHR users have faith in current protections, including HIPAA and the
EHR certification process managed by the Certification Commission on
Healthcare Information Technology (CCHIT).
• Existing EHR users should qualify for incentives, too. Seventy-seven
percent of small-group respondents and 82% of large-group respondents
(81% overall) recommend incentives from the government to retroactively
cover the cost of existing EHR implementations.
• Medical groups should be able to use funding to upgrade existing
EHRs. Seventy-three percent of all respondents support government funding
to upgrade existing EHR implementations.
Based on these results, the survey suggests that the new federal programs
now under consideration in Congress would be best served by:
• providing up-front grants for EHR purchase as well as ongoing
incentives for utilization, as groups with different characteristics
appear to be motivated by different approaches;
• including retroactive funding for practices that have already
adopted EHRs, as this will drive utilization of the EHR the benefits
accrue to patients, providers and to the federal government;
• helping practices with older or low-functioning EHRs to upgrade
to more current or fully functioning systems as many early adopters
may not have the capital to meet the current standards that may be required
in a pay for performance or pay for use program; and
• relying on existing privacy protections for patient information
rather than waiting for new policies to be agreed upon, with the understanding
that there are currently extensive security standards built into the
CCHIT certification process.
Source: Allscripts
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