Tuesday, April 29, 2014

Madness in the Medicalcare Sector

This is one occurs when the government gets more and more involved in healthcare. Dr. Daniel Craviotto is an orthopedic surgeon writes at WSJ:
The Centers for Medicare and Medicaid Services dictates that we must use an electronic health record (EHR) or be penalized with lower reimbursements in the future. There are "meaningful use" criteria whereby the Centers for Medicare and Medicaid Services tells us as physicians what we need to include in the electronic health record or we will not be subsidized the cost of converting to the electronic system and we will be penalized by lower reimbursements. Across the country, doctors waste precious time filling in unnecessary electronic-record fields just to satisfy a regulatory measure. I personally spend two hours a day dictating and documenting electronic health records just so I can be paid and not face a government audit. Is that the best use of time for a highly trained surgical specialist?

This is not a unique complaint. A study commissioned by the American Medical Association last year and conducted by the RAND Corp. found that "Poor EHR usability, time-consuming data entry, interference with face-to-face patient care, inefficient and less fulfilling work content, inability to exchange health information between EHR products, and degradation of clinical documentation were prominent sources of professional dissatisfaction."

In addition to the burden of mandated electronic-record entry, doctors also face board recertification in the various medical specialties that has become time-consuming, expensive, imposing and a convenient method for our specialty societies and boards to make money.
Expect that this useless type record keeping mandate will eventually go beyond Medicare and Medicaid patients and be required by the government of all physicians. It is not going to happen overnight, but  in time this central planning in the medical sector will result in a significant decline in the life expectancy of Americans.


  1. Doctors in America are now reaping the fruits of what they--and their lobbying organization--planted beginning in the mid 60s. Any provider who doesn't wish to have CMS dictating what they must use in an EHR is free to forego Medicare payments. Sadly, too many have come to rely on these as the backbone of their business model. It seemed so easy and lucrative 40 years ago.

    This isn't to say that if you only accept payment from commercial payers you can avoid the need to move to a full EHR, since we can expect these entities to mandate quality and other metrics which can only be provided efficiently by charting electronically. In additon, the expansion of ACOs and MSOs will drive EHR adoption, regardless of government policy dictates.

    The truly unfortunate thing about USG's interference in the EHR market is that it's forced developers to waste vast sums on programming to compliance, along with the time consuming and expensive testing process, resources which would otherwise have been devoted to meeting their customer's needs, rather than those of DC bureaucrats.

    1. I agree with this comment, but observe that for the most part, today's doctors are not the ones who lobbied for Medicare in the 60s. My libertarian doctor son never lobbied for, nor has ever consented to, the impositions forced on him by the older generation. Also, as you indicate, the Medical industry is now so cartelized and dominated by third-party payments that there is literally no options today other than to accept the existing system or not practice medicine at all. The famous libertarian Oklahoma Surgical Center exists only because it is grandfathered. It would not be possible to start another one like that today. There are a few admirable cash-only clinics, but the problem is that they can only provide trivial care. Anything further requires the cartelized and controlled hospital system. The only real viable remaining option is to locate to another country.

  2. EHR drove my R.N. girlfriend into early retirement...
    Also, good points, Unowned, Alan.