EMR courtship: Hospitals wooing doctors to stay afloat

A practical look at information technology issues and usage

By — Posted Aug. 23, 2010.

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With hospitals racing to meet meaningful use requirements -- and struggling with declining patient loads -- experts say hospitals want to hook up, technologically speaking, with physicians as a means of ensuring their economic survival.

Despite the hospitals' struggles to meet meaningful use criteria, which would award them bonus money from Medicare or Medicaid, they also are struggling to stay afloat in a bad economy. A recent report by the American Hospital Assn. on the effects of the recession found that 72% of hospitals reported a decline in the number of elective procedures, and 70% reported a drop in patient volume from 2009.

"The old saying used to be that most of the volume in a hospital is created by the tip of a physician's pen. Now it's the tip of the finger," said David Hampshire, senior partner and managing director of the health delivery business unit of the Falls Church, Va.-based consulting firm CSC. "I think [helping practices achieve meaningful use] is a strategy for hospitals to protect their referral channels."

But even though an offer from a hospital might look good on paper, experts advise not jumping on the first deal that comes along without developing your own meaningful use plan. "You can't just jump into this with two feet, make a splash and expect it to go smoothly," cautions J. Ryan Williams, a health care attorney at Walter & Haverfield in Cleveland.

One factor for getting a bonus -- as a hospital or a practice -- is proving the ability to share health information electronically. For many hospitals, the priority is showing that they can connect with doctors.

In a July CSC survey on how hospitals will meet meaningful use criteria, 54% of hospitals listed helping affiliated physicians achieve meaningful use as their first or second priority.

Balancing act

Hospitals must balance the desire to help physician practices with what they are allowed to offer under Stark law exceptions and anti-kickback safe harbors, which are set to expire on Dec. 31, 2013, said Claire F. Miley, an attorney with Bass, Berry & Sims in Nashville, Tenn. The safe harbors allow hospitals to help affiliated practices finance electronic medical records and other information technology.

This balancing act might explain why hospitals are taking different approaches.

According to the CSC study, 63% of hospitals already offer community physicians access to the hospitals' EMRs, and most of the other hospitals surveyed plan to do so. In addition, 39% of hospitals have teams that help physicians select and implement EMRs; 64% either offer a hosted EMR for physicians delivering ambulatory care or plan to do so. Thirty-three percent of hospitals surveyed have offered financial assistance to physicians to adopt EMRs.

Hampshire said 85% of survey respondents plan to meet meaningful use standards in 2011 or 2012. Fifty-one percent are targeting 2011, the first year bonuses are available.

A survey published in June by PricewaterhouseCoopers suggested that those who plan to meet meaningful use criteria in 2011 are 63% more likely to assist physicians. The study found that 78% of hospitals planning to apply for meaningful use bonuses in 2011 are assisting physicians now or plan to within six months.

The study also helps explain why these organizations are making physician practice readiness a priority. The organizations surveyed said meaningful use is likely to affect their relationships with physicians in referral volumes, employment arrangements, involvement in operational projects and physician involvement on governing boards of health IT initiatives.

Continuity of care issue

Richard Freeman, executive vice president and chief operating officer at Beth Israel Medical Center in New York, said his hospital has actively offered help to its affiliated physicians as a way to ensure continuity of care for patients.

"Whether it's an accountable care organization or medical home, there has to be a sharing of electronic information, and the way to do that is through the electronic medical record," he said.

Beth Israel is offering financial assistance to bring physicians onto its hospital's EMR. Freeman said the offer has made the decision about which system to pick easier for physicians, since the hospital already has vetted the vendor. Besides financial assistance, he said, physicians will have access to user groups that will help them maximize the EMR's use. And, like 75% of hospitals surveyed for the PwC study, Freeman expects that his hospital's offer to help physicians achieve meaningful use will lead to more physician involvement in other health information technology initiatives.

"I think as we develop physicians who start using the electronic medical record, they will become more interested in leadership positions and find it to be something they can use to be leaders in the molding of the health care delivery system," Freeman said.

Williams, who works with practices and has seen an uptick in the number of offers from hospitals, cautions clients to have their own plans for meeting meaningful use in place before accepting an offer from a hospital.

He tells clients that if they have money to hire a consultant, have the consultant test the various systems hospitals are offering against other systems they might consider. Physicians also should seek help developing a strategy for how they will meet meaningful use criteria and how a particular system will help them accomplish that goal.

"You could be in a position of accepting the donated technology, share in that cost, then one, two or three years down the road that technology, God forbid, doesn't allow you to meet your meaningful use criteria," he said. "What good have you done?"

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Bringing hospitals and doctors closer

A PricewaterhouseCoopers study published in June looked at how hospitals expect meaningful use to affect their relationships with physicians. Their answers help explain why many are offering to assist physician practices to meet meaningful use criteria.

Ways relationship will changeHospitals answering yes
Increase physician involvement in quality initiatives88%
Increase physician involvement on health IT governing boards75%
Increase EMR assistance72%
Increase involvement in operational projects62%
Increase employment arrangements50%
Increase referral volume32%

Source: "Ready or not: On the road to meaningful use of EHRs and health IT," PricewaterhouseCoopers' Health Research Institute, June

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External links

"Health Reform: Priorities and Challenges for Hospital Executives," CSC, July (link)

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