Why insurance companies want your EMR

Recently, insurance companies have gotten into the Healthcare IT business by underwriting EHR systems, hospitals, IPAs and non-profit organizations. These entities are in turn selecting "appropriate" Electronic Health Records to "donate" to you, in what could easily become the most expensive Trojan horse you'll ever receive. Third party payers expect that with "smart" templates and structured language, they can manage you and your practice by remote control, to "improve the quality of care" that you are rendering. Through the use of templates, third parties seek to exert greater control over your practice, limiting the scope of care you give to your patients, all in the name of cost containment.

By means of structured language, templates are currently being set up with intrinsic nomenclature designed to measure your performance against standards dreamed up by others. The methodology follows the well-known "Levels of Service" paradigm set up by the government about a decade ago, but has the potential to create a much more intrusive level of micromanagement.

Templates can be set up to limit choices and provide intimidating warnings. Schemes such as 'Pay for Performance' (P4P), although sugar-coated as a method to increase payment to physicians who practice "better medicine", will most likely result in automatic denial or reduction of payments to everyone else. If you thought waiting on the phone for permission to treat your patient was a nuisance, wait until you have to fight your templates!

It's no wonder third parties wish to promote template EHRs to you via the Stark Amendment! Are we supposed to believe that insurance companies are underwriting template EHRs to help you earn more money or provide your patients with better care?

The Lottery Psychology

A lottery works by magnifying the winnings of the few at the expense of the many. Advertising provides hopeful purchasers with the misguided illusion that there is a good chance of financial gain. Pay for Performance (P4P) works much the same way. The program claims doctors will practice "improved medicine" and therefore will increase their income. However, the vast majority of physicians will earn less, and in addition to decreased revenue, the loss of physician autonomy will be profound.

Templates do not optimize billing

Despite claims to the contrary, templates cannot optimize billing.

Medicare is well aware of the use of template software to artificially manipulate Levels Of Service and is auditing template EHRs carefully looking for cloning or inappropriate descriptors. These days, physicians must explain more in order to get paid less.

For example, physicians have reported Level 4 visits being blended down to Level 3 visits, as auditors know that templates tend to force every document into a Level 4, often inappropriately. Again, third parties would not be in favor of template EMRs if they thought overall provider revenue would increase as a result of their use. It's no secret that physicians are being paid less by insurance companies. According to "The 2006 Fee Schedule Survey" done by the journal Physician's Practice:

"Average physician reimbursement from commercial payers and Medicare collapsed in 2006, with payment levels averaging 17 percent below that of 2002 and a staggering 36 percent below that of 2004."

What's worse is that this trend doesn't seem to be improving! Take a look at the complete survey at the Physician's Practice website.

Certainly the vast majority of physicians wish to practice better medicine and would appreciate being informed of best practices at the point of care. However, there is a huge difference between commendable aspirations and being micromanaged by your templates. Praxis EMR offers a far better solution, one that respects your need to practice medicine your way, and yet still get paid appropriately.

Praxis EMR uses the power of the computer to free you from the restraints of templates and third party payers and allows you to gain control over P4P and any other scheme they might devise in the future, all while working entirely for you and your practice. With Praxis you practice better medicine, earn more money, and work easier.

Notes

The complexity of the issue is fully appreciated when considering ICD-10's and CPTs Codes, which are primitive in comparison to what is now being envisioned. Coding already takes up a good deal of a provider's valuable time and effort. In fact, providers must pay external coders to assist with this relatively straightforward requirement.

We suggest that the failure to adopt an EMR has less to do with physician phobia to new technology - as has been maintained by the software and insurance industry for quite a while - than it does with the instinctive realization by most practitioners of the implications and limitations of these misguided approaches to their everyday practice of medicine. Clearly there is no evidence to support that doctors are computer phobic, and the overwhelming technical and scientific background of most physicians speaks loudly against this view.