Employers & Other Players   

EHR Stakeholders - Unfulfilled Expectations

To a great extent the pressure to adopt EHRs is not coming spontaneously from the physician group practice (PGP) community directly; rather, it is coming UPON physician group practices because of growing frustration and dissatisfaction with healthcare in the U.S. In survey after survey of one stakeholder after another, various types of dissatisfaction is expressed with the U.S. healthcare system and the providers that work in it, including to some degree physicians. The trends in healthcare in the U.S. are uniformly troublesome; cost of labor is increasing as the supply of labor dwindles (RN and other provider shortages); costs of drugs is increasing; loss of coverage is increasing, with nearly 45 million Americans (many of whom are employed) having no healthcare coverage. At the same time, the advancing age of the U.S. population is increasing the demand for healthcare and causing an increase in acuity of patients treated. Length of stay is decreasing yet healthcare costs are increasing. A 29-hour stay on in a hospital for a drug eluting stent insertion is likely to result in a $29,000 bill - at $1,000 per hour, this dwarfs the costs of legal services. Quality of care is declining and the number of medical mistakes and adverse events is increasing. The doctor-patient relationship is becoming less personal and more rushed and patients (or their insurance carriers) are being proactively dumped by frustrated physicians who find it increasingly difficult to be reimbursed in a timely manner for the care they provide. Healthcare insurers are routinely under-reimbursing physicians (on average) for every patient seen (in some parts of the country) and going out of their way to find problems for which insurance companies delay the bills they do ultimately pay.

It is in this caustic healthcare climate that the pressure to adopt EHR solutions is emerging. Each stakeholder in the system sees some potential benefit in transforming and computerizing the system. That may be true for all except for the physician themselves, who as a group are fearful that the transformation that is being thrust upon them will undermine what little stability and margin is left in their practices. The EHR landscape in recent years is cluttered with both success and failure sagas. The atmosphere is filled with "vaporware" and EHR vendors spring up daily, some to grow and thrive and others to last but a short time and disappear (or change names and character) as they become food for their larger, less agile EHR competitors. It is in this setting that we take a look at some expectations of key stakeholders.

EMPLOYERS

Employers are finding that the continuous double-digit increases in yearly healthcare premium expenses are making them non-competitive and cutting seriously into net income margins. Healthcare insurance premiums have been increasing about 10% per year on average for privately insured workers for the last 6 years. Few businesses can sustain cost increases of 10% per year over extended periods when revenue increases are at less than half those levels. Such increases at large, global manufacturers like GM and Ford have made their product non-cost competitive in many world markets. Healthcare costs are increasingly being cited as major contributing factors to the failure of companies like United Airlines and other large employers in a variety of industries. This has lead to the formation of entities like the Leapfrog Group. Registered visitors are invited to read more about these trends and how the EHR is anticipated to help slow or reverse them.

PATIENTS

Patients are dissatisfied with extended waits in physician offices, frustrated by filling out the same information on an ever-increasing number of third party payer forms and with spending a large percentage of their ever decreasing "face time" with their healthcare provider watching while s(he) pages through reams of paper charts trying to find out what the condition was the last time the patient was there and what it is currently. Patients are hoping that the equipping of PGP offices with computer charting will allow the waits to be shorter, the delays in exam rooms to be less, the face-to-face time with physicians to longer, the delays in getting prescriptions refilled to decrease and that they may actually finally be able to receive a timely report of the results of lab tests.

QUALITY ORGANIZATIONS

Organizations concerned with the eroding quality of care (QOC) believe that computerization of the clinical aspects of medical care in the physician office will finally provide impartial, comparable, universal benchmarks by which healthcare delivered (and the healthcare providers delivering it) can be impartially measured. Thirty-three of these organization (and counting) are prepared to offer pay-for-performance (P4P) incentives to the top 15% of physician groups that can best provide quality patient care, for whatever that organization's specific standard of quality happens to be. Registered browsers are invited to learn more about these quality organizations, quality measures and P4P incentives being offered.

3RD PARTY PAYERS

Finally 3rd party payers, starting with CMS and including every non-government insurance group, are looking for new ways to deny claims and reduce reimbursements for care delivered. They are quite willing to reward the 15% of practices that can improve care with significant incentives, as long as they care REDUCE reimbursement to the other 85% of practices that fall outside of the top echelon of providers. So they believe that computerization of PGPs will make it clear (finally) which practices are in each group, paving the way to reduced reimbursement to those practices that fall below the ever-rising standards of care that computerized EHR systems will document. Registered browsers are invited to learn more about how some doctor's groups are fighting back and WINNING against these large, 3rd-party payers.