Study of 1,800 Healthcare Professionals Provides Insight into the Effectiveness of Current CMS Programs and Suggests a Blend of New Incentives from US Congress Would Produce the Biggest Impact
CHICAGO, Feb 02, 2009 /PRNewswire-FirstCall via COMTEX/ — An online survey of 1,888
physicians, medical group executives and staff, released today by Allscripts,
concludes that U.S. physician groups are eager to accept a proposed
multi-billion dollar package of government loans, grants and incentives
designed to promote broader adoption of information technologies such as the
Electronic Health Record (EHR).
The survey results reveal consensus among medical groups that funding is
critical, with 82 percent of respondents strongly agreeing that the government
should provide funding for Electronic Health Records via the HITECH(1) Act, a
key component of the proposed $825 billion economic stimulus package now under
consideration in the US Congress.
The survey also confirms that existing incentive programs managed by the
Centers for Medicare and Medicaid Services (CMS) — designed to encourage
hospitals to donate EHRs to physicians and to spur adoption of electronic
prescribing (e-prescribing) — have been effective. But on several key issues
that are central to the debate underway in Congress, the survey reveals a wide
variance in opinions among respondents. This is especially true when it comes
to deciding what form of payment the government should provide, whether
funding should be targeted toward the purchase of an EHR or incentives for use
of an EHR.
As a result, the survey findings clearly suggest the most effective route
to achieving widespread EHR adoption lies not in a uniform approach to all
physicians but rather a blended model of incentives that address the unique
needs of different physicians in different types of medical groups.
“This survey provides the first comprehensive look at the views of
physician practices related to the HITECH Act under consideration in the US
Congress,” said Glen Tullman, Chief Executive Officer of Allscripts. “The
results confirm our view that providing physicians with the incentives to
invest in and use an Electronic Health Record is the single most important
action we can take to improve the quality, enhance safety, and lower the cost
of healthcare in America. A critical point is that physician practices of
different sizes and technical maturities have different needs. If we want to
rapidly improve our healthcare system using technology to connect all US
physicians to each other, to their patients, and to the latest information in
real time, then it is important that Congress recognize the different
obstacles to adoption that exist and frame a solution that meets the needs of
all healthcare providers. This survey, direct from medical groups, provides
clear guidance on just how to do that.”
The goal of the survey was to gain insight into the perspectives and
preferences of healthcare professionals related to the current incentives in
place and the new proposed incentives for adoption and utilization of EHRs, as
well as privacy and security considerations.
Key findings included the following:
— Healthcare professionals support government incentives. Eighty-two
percent of respondents strongly agree that the government should provide
funding for EHRs via the HITECH Act.
— Current e-prescribing incentives are working. Seventy-five percent of
respondents to the survey are aware of the current e-prescribing incentives
from the Centers for Medicare and Medicaid Services (CMS), and 37 percent are
actively participating in the program.
— Current EHR subsidies provided by hospitals are effective. Over 10
percent of practices surveyed have already received an offer from a hospital
to help subsidize the cost of an EHR for their group under the Stark Safe
Harbor exception. The 2008 CCHIT Incentive Index(2) identified 50 programs
nationally involving 115 hospitals that are currently providing funding for
physicians. Taken together with the Allscripts survey, this data provides an
indication that the current program has gained traction in the market.
However the new programs under consideration have the potential to greatly
more significant adoption.
— The proposed incentives may drive significant new adoption. Sixty-eight
percent of respondents would be likely to participate in the pay-for-purchase
proposal under consideration in the Stimulus Bill, which provides sliding
scale financial incentives resulting in payments of up to $40,000 per provider
over 5 years as reimbursement for the purchase of an EHR. Only 2 percent of
respondents indicated they would not participate in this program, with the
remainder either unsure (25 percent) or unlikely to participate (3 percent).
— Groups without an EHR have equal preference for either a
pay-for-purchase or pay-for-use. Respondents from medical groups that do not
have an EHR expressed an equal preference for either a pay-for-purchase or
pay-for-use approach. Among all groups surveyed, preference for
pay-for-purchase decreased in direct correlation with practice size: 47
percent of respondents from groups with between one and three physicians
preferred to be reimbursed for purchasing an EHR rather than provided
incentives for its use; 32 percent of those from groups with between four and
25 physicians agreed; 20 percent of those from groups with 26 to 100
physicians agreed; and just 18 percent of respondents from groups of 100 or
more physicians agreed, with the larger groups strongly favoring utilization
— Providers are confident in existing privacy and security protections.
Sixty-one percent of respondents from groups with an EHR say they want to move
forward without waiting for new privacy standards, expressing confidence in
their EHR’s existing privacy protections. The results suggest that, while
privacy breach will always be a concern, experienced EHR users have faith in
current protections including the Healthcare Insurance Portability and
Accountability Act (HIPAA), and the EHR certification process managed by the
Certification Commission on Healthcare Information Technology (CCHIT).
— Existing EHR users should qualify for incentives, too. Seventy-seven
percent of small-group respondents and 82 percent of large-group respondents
(81 percent overall) recommend incentives from the government to retroactively
cover the cost of existing EHR implementations.
— Medical groups should be able to use funding to upgrade existing EHRs.
Seventy-three percent of all respondents support government funding to upgrade
existing EHR implementations.
Based on these results, the survey suggests that the new federal programs
now under consideration in Congress would be best served by:
— providing up-front grants for EHR purchase as well as ongoing
incentives for utilization, as groups with different characteristics appear to
be motivated by different approaches
— including retroactive funding for practices that have already adopted
EHRs, as this will drive utilization of the EHR the benefits accrue to
patients, providers and to the Federal Government
— helping practices with older or low-functioning EHRs to upgrade to more
current or fully-functioning systems as many early adopters may not have the
capital to meet the current standards that may be required in a pay for
performance or pay for use program
— relying on existing privacy protections for patient information rather
than waiting for new policies to be agreed upon, with the understanding that
there are currently extensive security standards built into the CCHIT
A white paper detailing the survey’s findings in more depth can be
downloaded for free at: https://www.allscripts.com/connect.
Quotes from Survey Respondents
The following comments on the survey were selected from the hundreds of
respondents who left comments and provided permission to have them published:
“The EHR has demonstrated unequivocally the savings of lives and dollars,”
said one survey respondent, Joel I. Silverman, a physician at Adult Medicine
of Broward and Palm Beach, in Deerfield, Fla. “We’re overdue for a major
shift in how physicians are practicing and are being paid for their efforts.”
“The EHR is the only answer for improved and more efficient medical care,”
said Cathie Lentz, practice administrator at Elmwood Center Medical Associates
in York, Penn. “Unfortunately the cost is out of reach for most physician
“I do think standards for privacy need to be developed, but this should
not hold things up since we already comply with HIPAA and take this into
consideration presently with our system set up,” said Patricia L. Fox,
practice administrator at Croser Keystone Health Network in Chester, Penn.
“Rapid adoption of an EHR is critical to improving the health status and
outcomes of the patient population we serve,” said Chuck Fitch, Chief
Information Officer of the University of Mississippi Medical Center/Delta
Health Alliance in Stoneville, Miss. “As the only academic health science
center in the state, we see patients from all over and have an essential need
to know their medical history, including medications, as well as the ability
to communicate treatment results back to their primary care providers. With a
patient population of over 1 million, this can only be done with technology.”
“When I started my solo practice in 2004, I took out extra loans to
purchase an EHR, which cost around $80,000 including computers and server,”
said Chris Buchanan, a physician at Brazos Urology Clinic in Granbury, Texas.
“I think it would be unfair to pay doctors to purchase new EHR systems without
rewarding doctors who have had them for years. The fact that I have a system
improves the quality of the care that I deliver through reduced errors,
24-hour access to patient charts when on call, etc. Therefore an incentive
should be given to all doctors who use EHRs.”
“I recommend use of any subsidy be applied toward one-time expenses such
as implementation training or license costs,” said Mark Gilbert, Director of
Operations at Practicare Medical Management Inc., in Liverpool, New York.
“Ongoing maintenance expense should not be covered. … I would be against
the stimulus being used toward fee schedule adjustments as the beneficiaries
would be the practices that already have an EHR. Providers need the monies to
get an EHR off the ground.”
“A program that only rewards new purchasers of EHR’s is quite unfair to
those who have already taken the plunge and paid for the systems themselves,”
said Jeffrey Johnson, MD, Medical Director of Central Utah Clinic, in Provo,
Utah and a former Microsoft Health Users Group Physician of the Year award
winner. “We have done much of the work to help EHR technology get to the
advanced stage of development it’s in today, and to not recognize that and
only reward the Johnny-come-lately’s in an incentive system would be grossly
“The stimulus bill may be the single most effective way to assure improved
quality and cost of healthcare,” said Larry Wiley, a staff member at
Washington Regional Medical System Clinics in Fayetteville, Ark.
Survey Methodology and Demographics
The survey invitation was sent via email to 50,000 healthcare
professionals in more than 13,000 medical groups. Conducted in January, 2009
by Allscripts, the Internet survey of 18 questions generated 1,888
— 242 C-level executives, 304 providers, 313 information system
professionals, and 1,029 practice administrators, managers and other staff.
— Participation from practices of all sizes with 444 respondents in
practices with 1 to 3 MDs (24 percent), 894 with 4 to 25 MDs (47 percent), 284
with 26 to 100 MDs (15 percent), and 266 with over 100 MDs (14 percent).
— A variety of practice types including 801 single specialty (42
percent), 596 multi-specialty (31 percent), 423 primary care (22 percent) and
71 “other” types (4 percent).
— Groups that currently had an EHR (1,148 or 60 percent) outpaced those
that did not have an EHR (740 or 40 percent) due in part to the significant
EHR user base of Allscripts, although we did not measure the number of EHR
users in the survey who use Allscripts EHRs.
All survey participants work in medical groups utilizing either EHR,
e-prescribing, practice management, revenue cycle management, document
management, or medication services products from Allscripts.
Allscripts (Nasdaq: MDRX) uses innovation technology to bring health to
healthcare. More than 150,000 physicians, 700 hospitals and nearly 7,000
post-acute and homecare organizations utilize Allscripts to improve the health
of their patients and their bottom line. The company’s award-winning
solutions include electronic health records, electronic prescribing, revenue
cycle management, practice management, document management, medication
services, hospital care management, emergency department information systems
and homecare automation. Allscripts is the brand name of Allscripts-Misys
Healthcare Solutions, Inc. To learn more, visit https://www.allscripts.com.
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- The Healthcare Information Technology Economic and Clinical Health
Act (HITECH Act) is part of the American Recovery and Reinvestment
Act (“the Stimulus Bill”).
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