As the mainstream media has begun to realize that organized physicians groups are doing all they can to resist adopting EHRs, the coverage of the dispute has revealed just how little impact their efforts—led by the AMA—are achieving in accomplishing their goals.
The AMA has come out vehemently against the Meaningful Use program and the high velocity with which the HHS and Congress want doctors to adopt EHRs, and they have written countless letters, position papers and blueprints for reform to announce their displeasure. Moreover, more than 30 other physicians groups have signed on to their copious letters. A recent USA Today piece quoted the incoming chief of the AMA about EHRs.
"Physicians passionately despise their electronic health records," says Lexington, KY, emergency physician Steven Stack, the American Medical Association's president-elect. "We use technology quickly when it works … Electronic health records don't work right now."
A 2013 AMA/RAND study revealed that EHRs are at the root of the modern doctor’s dissatisfaction with his job.
"Physicians believe in the benefits of electronic health records, and most do not want to go back to paper charts," said Dr. Mark Friedberg, the study's lead author and a natural scientist at RAND, a nonprofit research organization. "But at the same time, they report that electronic systems are deeply problematic in several ways. Physicians are frustrated by systems that force them to do clerical work or distract them from paying close attention to their patients."
Moreover, the AMA poured more than $19 million in 2014 into lobbying Congress to reign in HHS, CMS and ONC on health IT annoyances like the adoption of ICD-10 codes and Meaningful Use. While the program deadlines have been extended here and there for short periods of time, the IT trains are still running, if only a little behind schedule. When the AMA criticized CMS over the lack of a longer delay for ICD-10 adoption, outgoing CMS administrator Marilyn Tavenner slipped this quote into her blog post touting the 81% acceptance score from the latest test of the new codes.
"The US is the last major industrialized nation to make the switch to ICD-10," Tavenner wrote. "The structure of ICD-9, which is more than 35 years old, limits the number of new codes that can be created, and many ICD-9 categories are full. ICD-10 provides room for code expansion, so providers can use codes more specific to patient diagnoses."
Sounds a little like "It's happening. Get on board or pay the penalties." And those penalties could reach $200 million collectively for doctors.
According to a piece on Wall Street Cheat Sheet, there could be a couple of reasons why the AMA seems to keep getting shut out—namely the AHA and the Blues.
While the AMA had $19 million to lobby Congress, the American Hospital Association—which represents providers who took a financial hit after the last ICD-10 adoption delay—spent $20.75 million last year to lobby lawmakers. Big insurer Blue Cross and Blue Shield, which would also benefit from wide adoption of EHRs and ICD-10, spent $21.3 million in 2014. That's a combined $42 million, more than double the AMA's effort.
Now, factor into that the extreme amount of influence wielded by the tech sector—Google alone spent $17.5 million in lobbying Congress in 2014—and the scent in the wind becomes easy to identify. The tech sector stands to make billions from EHR creation and management. Insurers need ICD-10 and EHRs to bring better cost management into their industry, enabling them to spend less as they pay for more care for more patients. Finally, hospitals need the tech because the ACA is bringing millions of new patients into their doors, and the old pegboard and paper systems that doctors are trying to cling to just won't work for hospitals that see tens of thousands of patients each month.
The AMA has set up a showdown on ICD-10 and EHRs that it will lose, and lose big, because it just plain does not carry the muscle it used to.
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