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Comment: Re:stupid question but..... (Score 3, Insightful) 563

by docdoc (#26418521) Attached to: Obama Proposes Digital Health Records

Actually, so far such costs are indeed passed on to the providers. Charges for services isn't something providers generally get to choose themselves -- simplistically, a specific diagnosis or complexity of a patient encounter is billed at a fixed cost determined by medicare, and by discounted contracts between provider groups and insurers (eg, "in this market we agree to get reimbursed 70% of the usual rate to have access to your patients"). So far, such costs for retooling with technology have been passed on to the providers.

Providers have been very reluctant to put money and effort into large scale technologies because so far this has been essentially out of pocket, requires several years to implement, and is not subject to a standard. Our physicians group over the past few years has migrated to a fully electronic record and prescription system. It cost 10s of millions of dollars out of our practice. It slows us down compared to the old system so we can see fewer patients a day. It's limited in the sense that it forces you into certain "boxes" in terms of documentation that make the old flexibility of dictated charts go away. The upside is much more consistent access to data, simpler provision of records to other providers, etc. It still costs us several million dollars yearly to maintain, and still can't interact with other medical record or data systems, because there isn't a clear standard.

In a nutshell, we paid for it, it's made us more efficient in some areas, less so in others, and it's not clear on balance if it was worth it for us.

In another example, CMS (medicare) has implemented a "pay for performance" system, where providers identify several measure they'll get graded on and reimbursed higher if they meet those targets. Think grocery store shoppers club. So far providers are at best lukewarm -- after making substantial up-front investments (which again, we can't directly pass on to patients ourselves, but the system overall does in one way or another) we now have a byzantine system of reporting that nobody seems quite clear on how it works, and very limited reimbursement for our efforts that are making people think it would be cheaper overall just to take a loss on medicare reimbursement. So, standards and better information systems are an absolute must in many people's minds as doctors really do hate the tremendous inefficiency we currently have, but it's vastly more complicated and expensive than it seems...

Reality must take precedence over public relations, for Mother Nature cannot be fooled. -- R.P. Feynman

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