Monday, September 28, 2009

EHR subsidies from hospitals

Like the federal government, large hospitals are beginning to offer incentives for physicians who adopt EHRs. In New York, the North Shore-Long Island Jewish Health System is planning to offer its 7,000 affiliated docs subsidies of up to $40,000 each over five years, the NY Times reports. That’s on top of the up to $44,000 available from the stimulus bill.

This hospital’s size is unique (13 hospitals and a $400 million investment), but many hospitals are beginning to help affiliated docs adopt EHRs. And it appears hospitals are motivated by more than improving healthcare delivery.
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Of course, the investment aims to improve coordination of care, reduce unnecessary tests, and cut down on medical mistakes. But the effort is also a way for hospitals to “tighten the bonds,” the story says, between docs and hospital groups. Hospitals are competing for affiliated physicians, so this could solidify those relationships and potentially influence consolidation in the local markets.

North Shore may also benefit from the data from the EHRs, creating a database of evidence for treatments and procedures. The subsidy is up to 85 percent for physicians who agree to share data on patient measure that include glucose levels for people with diabetes and procedures and meds for heart patients. (The subsidy is 50 percent of the total cost for docs who install EHRs that link the office, hospitals, and labs.) Analysts say this move will be closely watched and hospital groups across the country will be rethinking their own plans.

2 comments:

  1. 1- Docs often do not trust hospitals with data on their office patients. One day the hospital will decide to employ docs and will "steal" all their patients.
    2- Our local hospitals did the math and found that to provide a subsidy to every doc on staff would cost millions. They cannot limit the subsidy to the active docs so the doc on staff who comes by once a quarter for one patient gets the money- and that's a huge loss.
    3- Unrelated to EHR, you mention sharing glucose readings from diabetics. There is scant evidence that controlling blood glucose in diabetes makes any difference in preventing MI, Stroke, death, etc. What counts is BP and cholesterol. See ACCORD, ADVANCE or VADT trials and the many editorials in Archives of Internal Medicine, including mine http://archinte.ama-assn.org/cgi/content/extract/169/13/1246

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  2. bcockrell@caahms.comOctober 2, 2009 at 11:30 AM

    The point to be made is that there is money available through hospitals for this purpose. The ARRA stimulus money, and future penalties, for EHR will push groups into this if they have not already seen the benefits of EHR. It's true you might not be able to do this for everyone, but not everyone will want it. If I'm a hospital, I see a great way to tie my staff closer to me by helping them do something they have to do and creating a, potentially, seamless information system. There are details on what needs / has to be tracked but that's not a reason to not consider this. As for the hospital "stealing" patients, it is the responsibilty of the groups to maintain patinet relationships and structure themsleves where that's not an issue.

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