During a Senate Appropriations subcommittee hearing on Thursday, Health and Human Services Secretary Sylvia Burwell faced tough questioning from senators about the difficulties providers are experiencing with electronic health records adoption under the Meaningful Use program and the rapidly approaching ICD-10 code switchover.
The government has spent $28 billion subsidizing electronic health records, said Senator Lamar Alexander (R-Tenn.) in the hearing on the HHS fiscal 2016 budget request. But, half the doctors are choosing not to participate in the program. Instead, theyll face Medicare penalties this year. Doctors dont like their electronic medical record systems by and large. They say they disrupt the workflow. They interrupt the doctor-patient relationship and they havent been worth the effort.
Alexander referred to an American Medical Association-commissioned RAND Corp. study in which doctors identified EHRs as the leading cause of professional dissatisfaction, emotional fatigue, depersonalization and lost enthusiasm. To address these issues, Alexander, who is chairman of the Senate Health, Education, Labor, and Pensions Committee, told Burwell that he and ranking member Senator Patty Murray (D-Wash.) have formed a bipartisan working group to identify five or six EHR problems that we can address administrativelyin other words, you could do itor legislatively if we have to.
Asked by Alexander if she would commit to making EHRs a priority in the year and nine months left in the Obama administration, Burwell replied that HHS has a group of staff ready to go and we are committed to do that. The HHS secretary added that we are looking forward to putting the list [of EHR issues] together and looking forward to getting it done. Well look at our administrative things and we want to work with you all on what we need legislatively as well.
Senator James Lankford (R-Okla.) expressed his concerns to Burwell about the potential negative impact of the transition from ICD-9 to ICD-10 on small physician practices. The concern is that theres not going to be a smooth transition from one to another, said Lankford, who worries that serious claims processing and cash flow disruptions for these practices on or after the October 1 deadline could result because of unpaid Medicare claims. He argued that gaps in payments could further expose some of these smaller providers.
However, Burwell assured the senator that theres only a very small group that is not ready, but during the period from now until October we want to continue to work with those providers and people will be ready so that there wont be those kinds of problems. According to the HHS secretary, as part of that process we have been doing testing and communication with large players and small players. Most of the large players have been ready and are ready.
Burwell added that the hospital associations have done surveys and we have very high percentages of people reporting that they are ready. For any of those that arent, we are still in the process of providing the technical assistance and we will go in to try and do the training.
But, Senator Bill Cassidy (R-La.), M.D., told Burwell that he found little comfort in the fact that large hospitals are ready for ICD-10. It is small practices that are most vulnerable, according to Cassidy. CMS estimates that in the early stages of implementation denial rates will rise by 100 to 200 percent, and that days in accounts receivable will grow from 20 to 40 percent, he said. That urologist in south Louisiana, whos in a one- or two-person practice, cannot afford to have denials go to 100 to 200 percent and A/R growing by 20 to 40 percent.
Cassidy recommended that CMS delay the penalty phase for two years as people transition to ICD-10 and struggle as well with EHR compliance. Unless we are sympathetic, the senator predicted that small physician offices will be driven out of practice.
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