A Radical Policy Proposal: Go Easy On Older Docs

flying cadeuciiThrough Dec. 15, federal regulators will accept public comments on the next set of rules that will shape the future of medicine in the transition to a super information highway for
Electronic Health Records (EHRs).  For health providers, this is a time to speak out.

One idea:  Why not suggest options to give leniency to older doctors struggling with the shift to technology late in their careers?

By the government’s own estimate,in a report on A 10-Year Vision to Achieve an Interoperable Health IT Infrastructure, a fully functioning EHR system, for the cross-sharing of health records among providers, will take until 2024 to materialize.The technology is simply a long way off.

Meanwhile, doctors are reporting data while the infrastructure for sharing it doesn’t exist.  Now, for the first time, physicians will be reporting to the federal government on progress toward uniform objectives for the meaningful use of electronic health records.  Those who meet requirements will be eligible for incentive payments from Medicare and Medicaid, while those who don’t may face penalties. In addition, audits are expected to begin in 2016.

Amid this shift to a new, data-driven healthcare system, the nation needs older doctors to keep practicing to meet presentneeds of an aging population, as well as an expanded Medicaid system. If burdensome reporting rules encourage retirements, as some studies indicate, the building of an information highway may result in the unintended consequence of a bottlenecked road to seeing a physician.  The likely result:  Nurse practitioners will deliver a greater share of the nation’s healthcare.

Some critics say the medical profession exaggerates a coming shortage of physicians.

Yet concierge medical practices are growing in number, luring those willing to pay a premium to see a doctor quickly for extended-time visits.

Last year, the New York Times reported on long wait times for doctor appointments as a new norm, and not just in traditionally under-served rural areas.  The article pointed to one study that found patients waiting an average of 66 days for a physical examination in Boston, and 32 days for a cardiologist appointment in Washington.

Think of what the wait times would be if mass retirements materialized, as suggested by findings of a 2014 survey of 20,000 physicians by The Physicians Foundation. Thirty-nine percent indicated plans to accelerate retirement due to changes in the healthcare system.Others reported plans to cut back on patient caseload or seek different jobs.

The potential for disruption is even more startling when you consider the number of older doctors in practice.  According to R. Jan Gurley, a physician writing on the  blog of the University of Southern California’s Center for Health Journalism, one in three doctors is over 50, and one in four is over 60 – despite roughly 20,000 newly medical school graduates a year.

Because of what’s at stake — potentially the very underpinnings of our nation’s healthcare system — health providers should speak out forcefully during the government’s open comment period.  Yes, it is late in the rulemaking game for EHRs.But new rules are being written for 2018 and beyond, and modifications are being made to rules in effect through 2017.

Would an outpouring of thoughtful, well-documented recommendations make a difference?  In a democracy, the answer should be yes.  The value of keeping older doctors in practice far outweighs the benefit of driving them crazy as they try to meet reporting requirements with often-clumsy EHR technology.  The challenge is to find a middle ground.

Diane Evans is a former Akron Beacon Journal editorial writer and columnist, and now publisher of the recently introduced MyHIPAA Guide, a news and information service for HIPAA-covered organizations trying to stay up with the seismic shift to a data-driven electronic health system. MyHIPAAGuide.com is hosting a forums discussion that is open to all who would like to share insights on key points that should be conveyed to CMS and government regulators. 

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5 replies »

  1. CMS doesn’t give a rat’s patooty about older docs. In fact, many docs think that driving out the older docs is part of the strategy.

    And of course EMR’s and meaningful use don’t benefit the patient anyway, but why worry about that?

  2. Great post! But I agree with Perry. Docs and their survival is the very last thing on CMS’ agenda. And the post from drson, below says it all. The public actually think that not forcing doctors into an EHR that doesn’t work and costs a fortune on top of it– is a “free pass.” What? “True for any industry?” What other industry has the federal government dictate what tools they use and how they use them? Does a landscaper have to buy a certain truck, mower, and billing system because the government says so? 20% cut? What?The public actually thinks that we get paid for any of the charting and EHR functions we perform? And since I’m really cranky today — ” extremely well paid.” Any bus driver makes more per hour than I made on my last medicaid patient. 1 office visit 25 minutes, 3 prescriptions requiring pre-authorizations, 24 minutes, patient’s daughter comes in late and wants me to review the medicines and has other questions 15 minutes, charting everything in my cumbersome EHR 20 minutes. Payment from Medicaid= $42.00. My overhead is 65%. A bus driver gets more.

  3. I don’t agree with this – Why should the older doctors get a free pass with the requirements? In any other profession, when there are new requirements, those are uniformly applied to everyone. I understand that the rules are burdensome but that is true for any industry. If the older doctors want preferential treatment, would they be okay to take 20% pay cut? Doctors are already extremely well-paid group (compared to our population) and asking a get out of jail card is not something that will go well with the general population.

  4. I think that patients will begin to refuse to have certain sensitive records placed on computers. Just a few more notable hacks…and the big NO is coming. We will have to have two systems, maybe one a LAN with no physical connecttions to any other networks including the phone and power and stiff regs against scanning and any other possible attachment point to the outside. There goes interoperability.
    Well, if you had an abortion at 8 weeks and your husband didn’t even know that you were pregnant, where would you want the record?

  5. Nice sentiment Diane, but I don’t see CMS caring much one way or the other based on its treatment of docs in general. And yes, you’re right the trend is for NPs and PAs to provide most of the care in future which I think is the ultimate goal.

    Writing this from the Akron-Canton area.