Can Hospitals Bully Physician Practices to Use their EHR?

If the Affordable Care Act stands as-is (and it likely will, at least for accountable care), providers have a significantly higher burden to provide a full range of care to their patients.  Their scope is broadening from providing care to an individual patient to that of an entire population.  In order to deliver on the promise of improved, coordinated care (while also being expected to lower costs), providers are re-evaluating how information is shared across their overall care network.  In particular, more attention is being focused on how technology be used for cost and quality metrics, provider network management, and care management.
At the most basic level, it is clear that some form of an EHR (electronic health records) will be needed to implement an ACO (Accountable Care Organization).  PricewaterhouseCoopers, in a recent briefing, found an overlap of 58 percent between quality measures required of an ACO and measures to achieve EHR meaningful use.  Even more so, as a part of CMS’s Pioneer initiative, it was initially required that at least half of the ACO’s primary care providers had to achieve meaningful use of their EHRs by the end of 2012 (this provision was removed however as part of CMS’s final ruling last October due to fierce opposition).  Clearly, the government thinks that EHRs are a necessity to realize accountable care.
Thus, heightened pressure is being felt in the industry to improve overall connectivity and collaboration among medical care providers, health insurers, and patients.  When thinking of the complexity of our health networks, this isn’t a straightforward task.  Providers will be expected to do a better job of managing key functions like credentialing, contracting, disease management, predictive analytics, personal health records, EHRs, patient communications, and reimbursements, among other duties.  It is reasoned then that a new onslaught of technology solutions are needed to make this happen.  And in fact, hospitals have seen an explosion of IT solutions in the past ten years to pull everything together, with a number of 400 different products and applications not uncommon for a single hospital.
Some experts however would argue a flood of new products and applications within a health system will not solve the problem.  Simply, a myriad of products not meant to be paired with each other will not get us any farther in improving transparency or interoperability.  More so, many believe that a single IT system is the only realistic option in today’s environment to achieve the necessary functionality required of accountable care.
We have seen here in Georgia that several systems have generally adopted this mindset.  They depend on a single system-wide electronic health system (like from a McKesson, EPIC, etc.) to manage the vast majority of the collection, analysis, and sharing of data.  They have in turn strongly encouraged their affiliates and local community partners to hitch their wagon to their stars.
Their results have been lackluster in winning over physicians to their side.  In a recent study of 260 physicians from FiercePracticeManagement, it was found that:
70 percent of independent practices did not plan to purchase the EHR product recommended by their local or affliated hospital, and
53 percent of system-owned practices have purchased or plan to purchase the recommended product.
Not all the reasons for a practice’s decision to ignore the recommendation of a certain EMR should be seen as a rebuke to hospitals.  The number one factor influencing the purchasing decision in fact was whether a clinical template specific to a specialty existed (a generic EMR was seen as less attractive by physicians).
The debate on whether a single system is necessary to realize accountable care is ongoing.  Yet, it is still clear to see from these results that additional work will be needed by hospitals and would-be ACO leaders to win over physicians and other providers to a recommended EHR system.  Even if we all agree that the fastest way to coordinated care is a single IT solution, physicians will need to see more in order to be convinced to join the party.
(On May 24th, we will be discussing this and more with a panel discussion with leading physicians, hospitalists and academics.  Details are here.  Come and join the conversation and feel free to bring a friend.)

If the Affordable Care Act stands as-is (and it likely will, at least for accountable care), providers have a significantly higher burden to provide a full range of care to their patients.  Their scope is broadening from providing care to an individual patient to that of an entire population.  In order to deliver on the promise of improved, coordinated care (while also being expected to lower costs), providers are re-evaluating how information is shared across their overall care network.  In particular, more attention is being focused on how technology be used for cost and quality metrics, provider network management, and care management.

At the most basic level, it is clear that some form of an EHR (electronic health record) will be needed to implement an ACO (Accountable Care Organization).  PricewaterhouseCoopers, in a recent briefing, found an overlap of 58 percent between quality measures required of an ACO and measures to achieve EHR meaningful use.  Even more so, as a part of CMS’s Pioneer initiative, it was initially required that at least half of the ACO’s primary care providers had to achieve meaningful use of their EHRs by the end of 2012 (this provision was removed however as part of CMS’s final ruling last October due to fierce opposition).  Clearly, the government thinks that EHRs are a necessity to realize accountable care.

Thus, heightened pressure is being felt in the industry to improve overall connectivity and collaboration among medical care providers, health insurers, and patients.  When thinking of the complexity of our health networks, this isn’t a straightforward task.  Providers will be expected to do a better job of managing key functions like credentialing, contracting, disease management, predictive analytics, personal health records, EHRs, patient communications, and reimbursements, among other duties.  It is reasoned then that a new onslaught of technology solutions are needed to make this happen.  And in fact, hospitals have seen an explosion of IT solutions in the past ten years to pull everything together, with a number of 400 different products and applications not uncommon for a single hospital.

Some experts however would argue a flood of new products and applications within a health system will not solve the problem.  Simply, a myriad of products not meant to be paired with each other will not get us any farther in improving transparency or interoperability.  More so, many believe that a single IT system is the only realistic option in today’s environment to achieve the necessary functionality required of accountable care.

We have seen here in Georgia that several systems have generally adopted this mindset.  They depend on a single system-wide electronic health system (like from a McKesson, EPIC, etc.) to manage the vast majority of the collection, analysis, and sharing of data.  They have in turn strongly encouraged their affiliates and local community partners to hitch their wagon to their stars.

Their results have been lackluster in winning over physicians to their side.  In a recent study of 260 physicians from FiercePracticeManagement, it was found that:

  • 70 percent of independent practices did not plan to purchase the EHR product recommended by their local or affiliated hospital, and
  • 53 percent of system-owned practices have purchased or plan to purchase the recommended product.

Not all the reasons for a practice’s decision to ignore the recommendation of a certain EMR should be seen as a rebuke to hospitals.  The number one factor influencing the purchasing decision in fact was whether a clinical template specific to a specialty existed (a generic EMR was seen as less attractive by physicians).

The debate on whether a single system is necessary to realize accountable care is ongoing.  Yet, it is still clear to see from these results that additional work will be needed by hospitals and would-be ACO leaders to win over physicians and other providers to a recommended EHR system.  Even if we all agree that the fastest way to coordinated care is a single IT solution, physicians will need to see more in order to be convinced to join the party.

(On May 24th, we will be discussing this and more with a panel discussion with leading physicians, hospitalists and academics.  Details are here.  Come and join the conversation and feel free to bring a friend.)

One comment Add your comment

Baby Boomer Writer

May 19th, 2012
3:30 pm

I recently quizzed two doctors about this: One a surgeon, the other an internist in Virginia. Neither had joined or contracted for the specialized software. One plans to retire in a year to avoid the whole process of health care delivery. The other told me it cost too much for a small practice to set up such specialized healthcare software programs. He estimated the cost at $90,000 and worried about potential liability if a mistake was accidentally made on a patient’s record.