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Why Aren’t Pharmas, Health Plans Paying for EMRs?

Posted on April 4, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

The following questions have been bothering me, and I don’t have answers. Maybe readers will be able to fill me in.

As far as I know, pharmaceutical companies haven’t been subsidizing or providing EMR software to medical practices, though I can’t imagine a better opportunity to a) form even closer ties with medical practices and b) get their message in front of physicians every day.

Attorneys, if you’re reading these, feel free to chime in and let me know if I’m not up to date; I realize laws governing donations to physicians are a moving target. But assuming it’s  still legal, I can’t see why pharmas haven’t jumped all over this idea.

I don’t know enough about pharma marketing costs to hazard a guess on what this strategy would generate financially, but I can only imagine it would be a winner.

Another stumper: why aren’t health plans investing in EMRs for their physicians on a large scale?

Not only would EMRs potentially improve efficiency and lower costs, they’d also give the plans an opportunity to build in real-time claims processing. That’s a huge win for both doctors and plans. From what I’ve read, health plans could save billions in paper transaction costs alone if they could use EMRs as a platform to connect processing directly.

As I see it, both of these industries have even better reasons to push EMR adoption than hospitals. Sure, hospitals need to connect with doctors, build loyalty and coordinate care, but the financial upside seems much larger — and more measurable — for pharmas and health plans.

So, this one’s on you, readers.  Why aren’t these other stakeholders getting into the game?  Hell, why aren’t employers taking a stand? (PHR efforts like Dossia don’t count in my view.)  Am I missing something here?

Salient Meaningful Use considerations from a provider’s perspective: part 1.

Posted on I Written By

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC in 2009. He can be contacted at doctorwestindc@gmail.com.

There are an abundance of good experts frequently found discussing important points in the world of meaningful use, both in print and in the blogosphere.  However, a friend and I were recently discussing the plans and released information for meaningful use and noted that many of the experts do not seem to be practicing providers who will directly participate in meaningful use.  Thus, the following considerations are not often discussed (as far as I’ve seen) but ones that I think merit attention.

1.  On January 1 2010, Medicare rescinded the ability of subspecialist physicians to use “consultation codes” for billing, which partially offset their increased reimbursements to primary doctors.  This meant that subspecialists would now get the same pay as a primary provider (e.g. gneral internist or family physician) for a given patient visit.  Aside from royally peeving subspecialists who have trained long and hard to obtain special insights into how to manage complex patients with problems in their areas of advanced training, Medicare was able to lower reimbursements to subspecialists by about 15% per patient seen.  As a result, subspecialty professional organizations such as the American Association of Clinical Endocrinologists (AACE), issued surveys of their own members asking for documentable proof of the obvious, that increasing numbers of subspecialists either (1) are not applying to become participating providers who accept Medicare patients or (2) are in the process of opting (dropping) out.

As more and more subspecialists drop out of Medicare, more and more elderly patients will have to go without subspecialty care when they may most need it, and more and more elderly will have to pay cash, out of shallow pockets, to see expensive subspecialty care providers.  This means, of course, more bad news for complex elderly patients.  Moreover, because many academic hospitals are required to accept Medicare patients, these hospitals sparse subspecialist providers will become overloaded and unable to see Medicare patients within an appropriate time period after diagnosis with a complex problem.  In my own field, endocrinologists who practice at academic hospitals typically take 3-4 months or more to see a new patient.

What does this all mean for Meaningful Use?  Less participating providers in the private sector and small practices, less data submitted for research purposes, and more heads being scratched wondering what the whole point was to begin with, IMHO.

Considerations 2-6 (or so) coming soon!

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC, as a solo practice in 2009.  He can be reached at doctorwestindc@gmail.com.