by Dr Sherri Tenpenny, DO, AOBNMM, ABIHM
In 2011, the Centers for Medicare & Medicaid Services (CMS) began a program to entice doctors and hospitals to incorporate the use of Electronic Health Records (EHR). The carrot? The promise of convenience, coordinated care, fewer medical errors, more efficient office visits, faster billing, improved access to medical records. Oh yeah, and they were told, “If you want to get paid, you must convert and bill electronically.”
The EHR programs were costly. The set up and implementation fees, which could be $30,000 or more, were required for each physician in a practice. Therefore, the government offered two incentive programs to encourage participation. The Medicare EHR Incentive Program offered to pay up to $44,000 over 5 years to cover the cost to implement a specific type of EHR, one that was certified to store and easily transfer structured data. The Medicaid EHR Incentive Program, offered to pay up to $63,750 over six years. In exchange, providers had to prove they were using the EHRs in a “meaningful way,” now simply referred to as “meaningful use”, or MU.
To date, more than 400,000 providers have adopted EHRs and are “meaningfully using” them. The sheer cost of the mandate, even with the incentives, forced many doctors to leave private practice and become hospital employees. They are now told how to practice medicine by administrators, insurance companies and the government. Once part of the system, doctors were forced to comply with EHR use and follow the MU criteria.
The CMS incentive programs came with a stipulation: data must be reported back to CMS. In 2014, providers had to meet the Stage 1 requirements, which included documenting 18 objectives, 13 were required and 5 were could be selected from a menu of 9 criteria. Beginning in 2015, the number of core objectives increased to 20 and physicians are now required to report 9 out of 64 total clinical quality measures (CQMs). Here is a sort list of CQMs reported to the government:
- Childhood Obesity
- Coronary Artery Disease
- Heart Failure
- Ischemic Vascular Disease
- Smoking Cessation
- Vaccination Status
- Adult Obesity
- Breast Cancer
One of the Stage 2 meaningful use core objectives is that hospitals and providers must electronically send your immunization data to a public health registry or to the immunization information system (data banks). In other words, if the state’s system can accept vaccine records, the data must be sent.
Compliance: Another stick
So, what happens if doctors and hospitals do not comply with these reporting requirements? Beginning in 2015, and each subsequent year, Medicare and Medicaid will decrease reimbursement by 1% per year, up to a maximum of 5% per year.
The EHR has turned out to be very different than advertised. Big Government, Big Data and Big Health Insurance promised convenience, efficiency and coordinated care. What are they instead? A Big Fat Lie. The truth is, these systems were created to spy on billing, collect data on patients and put government in control of doctors. They have nothing to do with improving patient care.
Your doctors may not have known how bad the government-mandated EHRs were going to be when they enrolled in 2011, but certainly they know how bad they are now.
Is it any wonder that, according to projections by the Association of American Medical Colleges, the nation anticipates a shortage more than 90,000 physicians by 2020 and 130,000 physicians by 2025? In a recent survey 1,527 physicians, 61 percent would not encourage a career in the medical field due to the impact of decreasing reimbursements, billing and collection hassles lifestyle choices. (And I would add, doctors are leaving due to fear of government retribution and the loss of the doctor-patient relationship.)
I actually saw this coming. In 2002, Tenpenny Integrative Medical Center made the hard decision to opt-out of Medicare and Medicaid participation. A clerical error could trigger a medicare audit, and the penalties for innocent mistakes could be staggering – $10,000 per infraction and up to 10 years in jail. And I knew that, eventually, the government would use EHRs to collect every possible statistic on every single person.
That’s why we still use paper records. We protect your privacy… and we do not administer vaccines.