Healthcare Experts Watch For EHR Dropoff By Docs

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Of the doctors who attested to Meaningful Use of their EHRs in 2011, 20% failed to participate in the federal incentive program in 2012, according to an analysis of government data by the American Academy of Family Physicians (AAFP).

The number of family physicians who re-attested fell by 21%, from 11,578 in 2011 to 9,188 in 2012. However, the number of doctors who attested to Meaningful Use stage 1 for the first time last year soared to 23,635, a 180% increase from the prior year.

Robert Anthony, an official of the Centers for Medicare and Medicaid Services (CMS), addressed the decline in second-year attestations in a presentation on July 9 to the Health IT Policy Committee, according to Jason Mitchell, director of the AAFP's Center for Health IT.

Anthony told the committee that about a third of the "non-returners," as CMS describes them, were physicians who had simply missed the deadline to register for the second year of incentives, Mitchell said. "Most of the rest of these folks, according to CMS, either retired, moved to a practice that didn't have an EHR or had problems with the vendor or the EHR itself," he added.

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But Mitchell and Steven Waldren, senior strategist for health IT at the center, suggested other causes for the decline in an article in AAFP News. While missing the deadline was part of the problem, they said, so was the transition from a 90-day reporting period in 2011 to a full-year reporting period in 2012. Decreased funding for the regional extension centers (RECs) that helped many physicians adopt EHRs and attest to Meaningful Use might also have contributed to the drop-off, they said. The RECs only have to help enrolled physicians achieve Meaningful Use in the first year, not the second, under their government contracts.

In an interview with InformationWeek Healthcare, Mitchell said that the doctors who attested to Meaningful Use in 2011 but not in 2012 tended to be early adopters who were experienced in using EHRs. If these tech-savvy, committed doctors couldn't attest for two years in a row, he said, it raises questions about whether other, less committed physicians will remain in the program for Meaningful Use stage 2, even if they attested in both years of stage 1.

"There's a real possibility that the folks who have been able to re-attest may take their $30,000 in incentives and say, 'It's not worth the push into stage 2.' The change from stage 1 to stage 2 is going to be very significant. And I think we'll see a significant slowdown in the folks who remain attached to the Meaningful Use wagon."

Evan Steele, president of SRS Software, which makes a government-certified EHR for specialists, also wondered how many physicians would hang in there for the long run. Just in moving from the first to the second year of Meaningful Use stage 1, he told InformationWeek Healthcare, doctors had to collect data for a period four times as long for an incentive that was one-third smaller -- $12,000 in year two vs. $18,000 in year one. Going into the second and third stages of Meaningful Use, he noted, "the incentives drop off precipitously, and the work that the doctor has to do goes up tremendously." The incentive is $12,000 for the two years of MU stage 2 combined, and it decreases further to a total of $2,000 in stage 3, he said. Even factoring in the penalties that the average practice would incur if it dropped out of the program, the financial benefit of remaining in it through 2016 would be only $11,000 per eligible professional.

Catherine DesRoches, a senior survey researcher for Mathematica Policy Research, agrees with Mitchell that, among the dropouts who were experienced EHR users, "It's possible that there may be physicians who decided that the attestation process [in the second year] was simply not worth the financial payoff." This would be especially true, she said, if they had small Medicare panels, because those doctors would not incur large penalties by leaving the program.

Regarding the implications for MU stage 2, however, she said, "This could be a temporary blip that we don't need to worry much about. But I'd withhold judgment on that until we know what the stage 2 numbers look like."

One relevant factor, she added, is whether doctors are employed by hospitals, which typically view health IT as part of their strategic plan for the future. Those physicians, she said, often don't have a choice as to whether to participate in MU.

"But for independent actors, there's a real risk that they're going to say, 'This just isn't worth it to me, and I don't have a big Medicare panel, so I can take the hit on the penalty side.'"

A new Deloitte survey found that 60% of physicians are satisfied with their EHRs, and that two-thirds of them are using EHRs certified to meet Meaningful Use requirements. The majority of the respondents reported that their systems provide benefits such as faster and more accurate billing (74%), saving time through e-prescribing (67%), and "communication improvement and care coordination capabilities through interoperability" (67%).

These findings didn't surprise Mitchell or DesRoches. In AAFP surveys that predate the Meaningful Use incentive program, Mitchell pointed out, 80% of FPs with EHRs said they'd recommend them to colleagues. "The majority of EHR adopters, even in early stages, were satisfied with the conversion and were recommending it to others," he said.

DesRoches similarly noted, "That's been a finding all along, that physicians who have EHRs like them and don't want to go back to practicing without them." In earlier years, there was some concern that the attachment to EHRs might be related to the tech-savvy nature of the early adopters. "But those findings seem to be holding even as more and more physicians are using these systems in their offices," she observed.

Although some doctors will undoubtedly drop out of the Meaningful Use program, she said, that decision will prevent them from keeping up with the changes coming to healthcare. "The technology issue is just one layer in a larger healthcare delivery redesign effort that's going on. Many of the things that physicians are going to be asked to do, like control the cost of their patients' care, will be difficult to achieve without a well functioning health IT system. So there are other incentives for physician organizations to take on this technology challenge, because what's coming down the road will require that kind of an information base."