Tech Talk - HIMSS 2010: A State of Confusion

MDNG Primary Care, April 2010, Volume 11, Issue 4

Big money is flooding the health IT industry, and that can mean only one thing: Doctors are about to get screwed.

The recently completed 2010 HIMSS conference and exhibition in Atlanta was full of big tradeshow booths‑‑just one of many signs the health IT industry is being flooded with VC, M&A, and Wall Street money. And why is “smart money” gushing into health IT like it’s the next gold rush? Could it be that we physicians have a giant target on our backs that marks us unsuspecting dupes just waiting to be separated from our wallets? I’m starting to wonder…

During my three days at HIMSS, I visited many EHR vendor booths, as well as the informational booth set up by the Office of the National Coordinator for Health Information Technology (ONC), the organization responsible for coordinating and informing the public as to the actual details of ARRA and HITECH. I presented myself as a having a small family practice in Rhode Island collecting $16,000 per year from Medicare‑‑all of which is 100% true. I asked vendors and the ONC how much money I would be able to collect for “meaningful” use of a “certified” EHR system. I asked them whether I would be able to collect the $44,000 that so many vendors promise. I also pressed for specific details, such as how the payments would be made, how often, etc.

Adventures in Wonderland

What happened next literally blew my mind. I felt like Alice wandering though Wonderland as people said things to me that were not rooted in reality. The answers I got from vendors were all over the place‑‑ranging from promises that I will collect all $44,000 under the assumptions I gave them (not true!), to confessions that they were unsure. No two had the same answer, and only one company (GE) had the right answer. One vendor’s representative even confused the Medicare and Medicaid subsidies, promising me a whopping $65,000 pay day courtesy of the stimulus money. Five different federal officials at the ONC booth did no better than the vendors. Not one of the folks at that booth could answer my simple question.

So what is the reality?

The simple answer is that eligible providers will be able to collect the lesser of up to 75% of their total Medicare allowables (aka collections) in each of the five years beginning in 2010, or a maximum annual amount that changes year to year as shown at left.

This equals a total of $44,000 from Medicare (if you collect $24,000 or more from Medicare each year). So, while it is true that you could get up to $44,000, what many vendors fail to explain is that if you collect less than $24,000 from Medicare per year, you get less. In other words, the correct answer to my question is that my practice should be eligible to receive $38,000, which is a full $6,000 less than many physicians are banking on.

This would be laughable, until you think about the fact that thousands and thousands of overworked and underpaid small-practice physicians are going to pay outrageous sums for substandard solutions, all in the false expectation of some giant windfall at the end of the day. Shame on EHR vendors! Who do you think will get the short end of the stick when a physician, misled by unscrupulous EHR vendors, spends tens of thousands of dollars on an overpriced EHR?

For a more detailed report of my adventures at HIMSS, and the actual ludicrous answers I got to the questions posed to EHR vendors and the ONC, please see my blog.