AMA meeting: Doctors object to penalties for avoiding EHRs
■ Delegates call for eliminating Medicare penalties for failing to show "meaningful use" of electronic records by 2015. But some fear incentives could also go.
Chicago -- Physician-delegates at the AMA Annual Meeting in June formally came out against planned penalties included in this year's federal stimulus bill that would dock Medicare pay for physicians who do not have a qualifying electronic health record.
The "adjustments" start at 1% of the physician's Medicare fee schedule and are set to begin in 2015, after four years of available incentives for adoption. The penalties are set to increase each subsequent year to a maximum of 5%.
Delegates passed a resolution calling for the Association to ask the federal government to eliminate the penalties and advocate for federal assistance with up-front and maintenance costs of EHR use.
The stimulus package, officially titled the American Recovery and Reinvestment Act of 2009, sets out incentives for both physicians and hospitals who can demonstrate "meaningful use" of an EHR, including the use of an e-prescribing component. Qualifying physicians will be eligible for additional Medicare payments of as much as $44,000 over the course of five years, beginning in 2011.
The national Health IT Policy Committee, an advisory group charged with defining principles for "meaningful use," released its first draft recommendations June 16, but the Centers for Medicare & Medicaid Services has indicated proposed rules won't be released until late 2009.
There is a case-by-case exemption written into the law for physicians who can demonstrate "significant hardship, such as in the case of an eligible professional who practices in a rural area without sufficient Internet access."
Delegates at the Annual Meeting argued that the penalties violate the AMA's pay-for-performance policies and unfairly punish physicians who can't afford the up-front cost of adopting an electronic record system.
"My financial calculations say it's cheaper for me to take the penalty than to put the system in, and that's what I'm going to do," said David McKalip, MD, a neurosurgeon and alternate delegate for the Florida Medical Assn.
No coverage for up-front costs
There are no provisions in the stimulus package that cover the up-front cost of adopting an EHR for a physician in private practice, and some physicians are concerned about buying an EHR now without knowing exactly what type of system will qualify them for incentives.
"Whatever you're buying now is going to be obsolete in the near future," said Stephen Sebert, MD, a family physician and president of the West Virginia State Medical Assn.
Other physicians speaking to the issue in reference committee urged delegates to "not throw the baby out with the bathwater" and pointed out the incentives represent the first assistance the government has offered for health IT adoption.
"I think if we ask for this to be rescinded, what we'll wind up with, possibly, is nothing," said Steven Kanig, MD, a nephrologist and delegate for the New Mexico Medical Society.