Take the Money and Run? GAO Reports Significant Dropping Out of Government Electronic Health Records Program

A previous blog entry noted that Veterans Affairs and the Department of Defense have utterly failed to execute a plan to develop an interoperable Electronic Health Record (EHR), despite five million beneficiaries receiving health benefits from both bureaucracies.

Despite its inability to manage this for two closely related federal departments, the federal government decided to try the same thing for private hospitals and physicians nationwide. The 2009 HITECH Act authorized billions of taxpayer dollars be spend to pay hospitals and physicians “incentives” to adopt EHRs. The Congressional Budget Office estimates that the total tab will be $30 billion from 2011 through 2019.

The Government Accountability Office has just reported on the results. Not surprisingly, with so much money being spent, there was a lot of uptake. 45 percent of eligible hospitals had EHRs in 2011, versus 64 percent in 2012. For physicians and allied professionals, the share went up from 21 percent to 48 percent.

Hospitals and physicians did not get paid just to buy EHRs and leave them in a closet. They had to demonstrate “meaningful use.” However, we are still in stage 1 of meaningful use, which demands only that 30 percent of patient records be entered by computerized order entry.

Stages 2 and 3 have much higher bars, which providers are unlikely to fulfill. The GAO notes that only 15 percent of professionals reported on an optional stage 1 measure to provide a summary of care document at each care transition or referral. This document is mandatory for stage 2.

In other words, the EHR meaningful-use incentives have caused providers to execute inputs in return for money, but not outputs. One sign that the program is failing is that the high net-adoption rate disguises significant drop outs:

Specifically, within the 36 states that had completed their determinations of which providers would receive incentive payments for the 2012 Medicaid EHR program year, 61 percent of professionals and 36 percent of hospitals that participated in the Medicaid EHR program in 2011 did not continue in 2012. Sixteen percent of professionals and 10 percent of hospitals participating in the Medicare EHR program in 2011 did not continue to participate in 2012. (p. 23)

It looks like the federal government is churning through $30 billion to incentivize hospitals and physicians to license EHR suites from vendors that they use for a year and then let sit idle.