Curbside Consult with Dr. Jayne 1/13/14

This is the last of a three-part response to a reader’s comments on EHRs (Part 1, Part 2.)

What is meaningful for the government is not meaningful for the patient. We sacrifice good care so the government can collect statistical data for free.

I’ve written on this topic before. It’s easy to play armchair quarterback and to dissect things through the retrospectoscope. Surely parts of the program might be different if the creators had it to do over again. I personally don’t like to be penalized for poor outcomes. It doesn’t matter how motivationally I interview, how well I design care plans, how well my team works with the patient, etc. – sometimes patients simply don’t want to do the right things for their health. Sometimes they are genetically doomed regardless of what we do. Sometimes they can’t afford to do the things we recommend, or choose to prioritize other needs or wants.

Most physicians are genuinely motivated to help people live longer, healthier lives (sometimes to the detriment of quality of life, but that’s another topic for another day) and are personally burdened when we can’t make someone better. Adding financial penalties for things which are not entirely under our control is offensive to those of us who work our tails off trying to do the right thing.

You want to ding me for failing to put someone with proteinuria on an ACE inhibitor or an angiotensin receptor blocker? Fine, I deserve it. You want me paid less because I write bad prescriptions that no one can read? Great. But don’t penalize me because Uncle Sal won’t get a colonoscopy despite a decade of counseling, discussion, debate, and downright begging. I’ve done all I can do.

As far as the “free” factor, technically we’re being compensated for our data through the various quality reporting initiatives, as well as through MU, so saying we’re giving it away for free may not be entirely accurate. Most of the clinical quality metrics revolve around good care, so it’s hard to argue that quality is sacrificed. But I respect the comment.

I’m generally not a fan of the conspiracy theories, but I wonder if the government wants to slow us down so they pay for less visits and care? We’ll never know the truth, but what better way to slow us down than Meaningful Use?

I admit I’ve had this thought before. Nationally, many physicians are refusing to accept Medicare, refusing new patients, or limiting their panel sizes, but it depends on your market. We have a lot of people that limit Medicare in our region because other insurers pay better and there’s plenty of demand, but that’s not the case everywhere. There are plenty of markets where Medicare is the top payer and physicians can’t afford to stop participating. The same applies to Medicaid. Several of my blogger friends hypothesize that it’s a ploy to get rid of primary care physicians and …read more