AUBURN – The doctors at Grove Medical Associates aren’t above a bit of friendly competition.
So when Office Manager Gail Cetto showed the physicians how often they were using the electronic health records to submit prescriptions to pharmacies, Dr. John E. Kelly took note and decided he would not let fellow physicians Dennis E. Murphy and David E. Weinstock outscore him.
“It’s done in good jest, but there’s no way I want to be second to Weinstock or Murphy,” Dr. Kelly said with a laugh.
Across Massachusetts, physicians have spent the past decade flipping the switch on electronic health records with more or less success than the Grove Medical doctors. Nearly all Massachusetts physicians in larger practices had access to the records by 2013, and about 75 percent of smaller practices with one to nine doctors had access, according to the Massachusetts Medical Society.
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Successfully using the records to make health care safer and more efficient is a different matter. Some physicians have grown so fed up with the investment of time, energy and money needed to certify their use of the digital documents that they prefer to simply accept lower payments from the federal Medicare health program for seniors and people with disabilities.
“Some of the physicians really are suffering from poor implementations or poor products, and it’s interfering with their ability to give care, and so they’re saying this is so painful, that I’m willing to give up thousands of dollars every year so that I won’t have to live with this pain,” said Dr. Lawrence D. Garber, an internal medicine doctor and medical director for informatics at Reliant Medical Group in Worcester.
Electronic health records, sometimes abbreviated as EHRs, are digital replacements for the paper files that doctors, nurses and other medical professionals long used to record information about patients. They also contain tools to help medical professionals such as notifications about drug interactions.
As physicians and hospitals adopt EHRs, the industry is booming. Consulting firm Accenture estimated the worldwide market for EHRs will hit $22.3 billion by the end of 2015.
It’s tougher to find what the average physician pays for EHRs, however. The most widely cited studies date to 2005 and indicate costs of $25,000 to $45,000 per physician. Software licenses and other ongoing expenses add to that.
To help doctors finance the switch, the federal government began paying incentives in 2011 to physicians who showed they were using EHRs in stages to impact patient health. As of June 2014, more than 403,000 physicians, or 75 percent of eligible U.S. professionals, had received payments for the “meaningful use” of EHRs under programs run by Medicare and Medicaid, the state-federal health plan for the poor, according to a report to Congress.
In Massachusetts, 10,442 providers are signed up for the Medicare incentive program, and 6,294 are signed up for the Medicaid program, according to the Massachusetts eHealth Institute. A total of 286 Worcester physicians have shown they reached the first stage of meaningful use under the Medicaid incentives program, the institute said.
All that work has brought in money. A federal database showed the government had paid $33.7 million to Massachusetts physicians, as of March, for reaching the first and second stages of meaningful use.
Still, for some practices, the cost of adopting EHRs has been high. A 2013 analysis of 49 community health practices Massachusetts found the average physician would lose $43,743 over five years.
Starting this year, physicians are also facing lower payments from Medicare if they cannot show meaningful use of EHRs.
It’s understandable the government would set meaningful use standards, but meeting some of the standards, especially in the second stage, can be difficult, said Dr. Dennis M. Dimitri, president of the Massachusetts Medical Society and vice chairman of the department of family medicine and community health at UMass Memorial Health Care of Worcester. A practice with a number of elderly patients might have trouble engaging a large number to use an online portal to see their medical records, he said.
“Physicians are not averse to new technology,” Dr. Dimitri said. “Obviously, a big part of what we do is technology dependent, but we like to have technologies that make them better, not more difficult.”
At Grove Medical Associates, the story is different. The practice, which serves more than 6,500 patients, estimates a 315 percent return on its investment in EHRs and has been named winner of the annual Davies Award of Excellence by the Healthcare Information and Management Systems Society. All of the physicians have attained the second stage of meaningful use of EHRs.
Grove Medical, formerly in Worcester, implemented an EHR system from eClinicalWorks LLC of Westboro in 2005. It added electronic prescriptions in 2007 and more recently adopted an online portal that allows patients to send messages to physicians.
The system even does some things automatically, sending voice and text messages to patients before appointments and checking patients’ insurance eligibility the night before appointments, according to materials that Grove submitted for the Davies Award.
Dr. Kelly, one of four physicians at the practice, said EHRs allow him to see in a clear, efficient manner the patient information that previously would have filled a paper file several inches high.
“Now all I’ve got to go is click, click, and it’s right there,” he said. “You’re not just looking at a snapshot of a patient, you’re looking at the movie.”
Implementing EHRs was not cheap for the practice, however, especially initially. It estimated more than $1 million in expenses between 2005 and 2013 in its award application.
But the practice estimated more than $4 million in savings and increased collections over the same period. One of the critical factors was better documentation of services.
“If you don’t document it, you didn’t do it, as far as insurers go,” Dr. Kelly said. “We were doing the work, but we weren’t documenting it in a fashion that the third-party payer would be receptive to, so I think that made a great difference.”
Date: May 16, 2015