• What’s behind the 17% EHR Incentive Program dropout rate?

    Author | Date June 27, 2013
    The pace at which eligible providers are leaving the EHR Incentive Program is higher than most high school dropout rates, according to the latest data from CMS.  Seventeen percent of providers who collected a 90-day incentive payment in 2011 either decided not to pursue the program for the following full year or were unable to sustain their efforts for that long.  Despite the continued increase of new providers joining the program, the rate of failure is astonishing and somewhat troubling.  If meaningful use can’t hold on to participants by offering big incentives, what will happen when that money goes away – and what does that say about the deeper issues underlying EHR adoption in the United States?
    Some EHR implementations simply detonate on impact, falling prey to poor planning or the dreaded EHR backlash from unhappy physicians and clinical staff.  Other providers find that their first EHR system doesn’t meet their needs, and hunt for a replacement that better suits their practice’s style, which might delay their participation in meaningful use by a few months.  But after investing in a certified EHR, adapting their workflow to successfully meet the EHR Incentive Program’s requirements for three months, and collecting their money from CMS, why would a provider decide that continuing on that path just isn’t worth it?
    One reason might be the number of providers caught in the no man’s land of being desperately unhappy with their EHR, but unable to afford a replacement.  In a recent Black Book survey, 8% of providers indicated that they’re dissatisfied with the software they chose, but it’s simply too expensive to do anything about it.  With 79% of disgruntled providers admitting they didn’t do enough research during their initial purchasing process, and more than 80% of specialists frustrated with products that don’t meet their needs, maybe it’s just too much to wrestle with frustrating, inadequate software every day and try to collect all the additional data required by the meaningful use program at the same time.
    In addition, another recent survey indicates that 14% of respondents who successfully attested to Stage 1 don’t plan to continue their participation when Stage 2 comes into effect.  Stage 2 raises reporting thresholds and adds patient engagement and health information exchange requirements at the same time that ICD-10 is scheduled to slam providers with questionable revenue effects and major documentation adjustments.
    Is it all simply too much?  Maybe.  But providers who accept Medicare patients will be facing payment adjustments in 2015 if they don’t stay on the path of meaningful use.  The initial 2% penalty might not seem like much, and some EHR opponents are telling physicians just to take the hit instead of throwing money down the drain to adopt an EHR and train staff to participate in time-consuming data collection that doesn’t improve their daily patient care.  But it’s a risky choice, especially as baby boomers age into Medicare eligibility at an increasingly rapid rate.
    It’s no secret that physicians just want to practice medicine.  They want to spend time with their patients and have the freedom to decide how to run their own businesses and take their own notes.  Not everyone sees the EHR Incentive Program as an effective way to make medicine smarter and reduce costs.  Not everyone agrees with the ONC’s methods of fostering interoperability of health IT systems, or the way CMS is threatening non-compliant providers.
    But left to its own devices, it’s unlikely that healthcare would make the necessary sacrifices to bring it into the digital age and realize the benefits of health IT.  It’s clear from the haphazard and reluctant ICD-10 transition that people will put off anything that isn’t mandated as long as humanly possible, no matter how inadequate their current state of affairs.
    Meaningful use may be painful, and it may be difficult.  It may not be perfect.  However, providers who drop out of a program that’s paying them to participate are setting themselves up for an uncertain future, and need to think carefully about frying pans and fires before choosing to leave meaningful use behind for good.
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    3 Responses to What’s behind the 17% EHR Incentive Program dropout rate?

    1. David Deitrick says:

      While I don’t think medicine would adopt widespread EHR use without some sort of encouragement from the government, nor do I believe that EHR vendors would create programs with the kinds of interconnectivity we really need in medicine without government encouragement, I don’t think the software is well designed or ready for “Prime Time.” The available software I have seen feels more like old DOS programs from 20 years ago, not the slick programs & interfaces seen with modern software. The end user does far too much work that should be done by the technology. To date, EHR software makes users do more work, increasing both the time it takes to document a patient encounter, and the distraction of the EHR reduces the ability of the end users to concentrate on their primary responsibility, the patient.

      Until EHR’s stop getting in the way of patient care and start to effectively help us get our work done, all of the other “benefits” of the technology are only available to the auditors of health care records, not to the patients we are supposed to be taking care of.

    2. John Tempesco says:

      Here is the opinion of a casual observer of the process resulting from interaction with many physicians across the country. Non-institutional physicians (those not gobbled up by integrated delivery systems, hospitals and large group practices) are afraid. Although they looked at the initial money as an incentive to implement an EHR in the beginning and they were at the stage of “self-attestation”, they became concerned at how the program would be administered in the long run. When ONC announced that the Office of Civil Rights (OCR) was going to audit them for security violations and heard of the large fines associated with non-compliance with a set of vague and onerous regulations, they simply could not afford another costly administrative program within their small business. Physicians operating independently or in small groups cannot keep up with the ever changing regulations and interpretation of them; they cannot hire a security officer; take time to train everyone on cyber security; or afford additional practice liability insurance to cover government imposed fines for non-compliance with system they were almost forced to use. This is especially true in an environment where OCR officials brag about the fines they are levying and respond to questions from small group practices with answers like, “you better understand that you are a business and this is the cost of doing business.” Like every other government program, the money not only has strings attached – it has ropes and chains. Until the government drives every solo and small group practice out of business, more and more of them will drop out of this program.

    3. A Avis says:

      Physicians are caught between a rock and a hard place. Medical documentation requirements imposed by insurers and the government are asinine; rather than documenting only what was done to diagnose and treat the patient in a manner that another physician could understand, MDs are required to document an equal or greater volume of social and demographic information in addition to Dx and Rx info, and to do so in a way that the average 5th grader can read it, even though that 5th grader can’t understand it and doesn’t understand the significance of what is presented. This sad state of affairs was brought to us by the legal and regulatory industries. Now, with the advent of EMRs, the documentation demands of the regulators are growing (!!), while the method of documentation has become more difficult. If you examine the best EMR software on the market (whatever you choose – it doesn’t matter) and examine the worst, you’ll find they share one commonality – a horrid maze of checkboxes, dropdown boxes, text fields and radio buttons all intended to “ease” the physician’s documentation workload. But the enormous array of input methods is insufficient – on a daily basis physicians come across a patient who simply doesn’t fit the available descriptions, leaving the poor doc to either document inaccurately or incompletely, or to revert to the keyboard to laboriously churn out a valid chunk of text – which the lawyers/insurers/regulators might deem to be inadequate or :out of compliance” (gasp!). The only currently feasible approach to loading accurate information into the EMR with any hint of efficiency involves dictation and either transcription or voice recognition, but the external powers consider that anathema as it doesn’t produce “computable” output. The problem is really very simply defined – documentation requirements are unduly burdensome, documentation methodological demands are unreasoable, and the payers are unwilling to bend on the issues. The only sane approach for a practitioner is to drop out of the 3rd party payer universe entirely and open a direct pay or “cash” practice, in which the payers can no longer exert their inane power.

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