ing issues and develop data to support advocacy efforts. Each month throughout 2012, TMA emailed a portion of the survey, including questions related to professional satisfaction, to phy- sician and resident members and nonmembers. Respondents to TMA’s survey say the biggest concerns for
Texas physicians are ensuring economic viability of their prac- tices and maintaining adequate payment — particularly from Medicare — to cover rising practice costs. Dr. Bias, who cur- rently accepts new Medicare patients, says he shares his Texas colleagues’ unease.
“Small private practices lack the volume of providers and
revenue streams to weather financial storms. Improving pay- ment from private and government payers would help us gain the resources we need to survive and would improve physician professional satisfaction and patient care,” he said. TMA offers tools and services to help physicians survive and thrive in the current health care landscape. TMA plans to launch its Physician Services Organization (PSO) early this year. The PSO will arm practices with the strategies and ser- vices they need to succeed in an accountable care environment, while remaining independent if they so choose. (Read “Most Valuable Players,” pages 23–27.)
Cumbersome, costly EHRs
The RAND study found physicians feel current EHR technol- ogy interferes with face-to-face discussions with patients, re- quires them to spend too much time performing clerical work, and degrades the accuracy of medical records by encouraging template-generated notes. They also worry that the technol- ogy costs more than expected and that different types of EHRs cannot “talk” to each other, preventing the sharing of critical patient medical information when needed. Efforts are under way to improve information sharing
across different systems through health information exchanges (HIEs). For more information on the progress of HIEs in Texas, visit
www.texmed.org/hie, and scroll down to Vital Connec- tions: HIEs Improve Patient Care. “In virtually every practice, physicians had significant is- sues with EHRs. There seemed to be an overall sentiment that EHRs may have the potential to help physicians take care of patients, but they also require physicians to spend a lot of time accessing and entering patient information,” Dr. Crosson said. Texas physicians have their own stories about EHR hassles. David Fleeger, MD, an Austin colorectal surgeon and a
member of the TMA Board of Trustees, is one of eight surgeons in a subspecialty group that implemented an EHR in 2010. His group spent six months to a year customizing EHR templates to apply to the practice and conform to physicians’ workflow. “We used to pay for dictation services. We eliminated that cost, but now we spend more time every day completing our charts,” he said.
Abilene family physician Allen Schultz, MD, treats a wide range of diseases, many of which are easy to recognize but some of which are subtle. He worries that constantly evolving technology and regularly scheduled EHR software upgrades may have unintended consequences that harm patient care.
“This increases my concern for missing a clue that might negatively affect my care for a particular patient,” said Dr. Schultz, a member of TMA’s Ad Hoc Committee on Health Information Technology. Indeed, Dr. Schultz says his colleagues often bemoan EHRs’
erosive impact on the physician’s interaction with the patient. “Although it’s nice to get a good medication history elec-
tronically and to know my prescriptions are arriving at the pharmacy as promised, I fear the increased administrative re- quirements and complexity of the Medicare and Medicaid EHR incentive programs may tip the balance. The hindrances and detrimental effects could outweigh any improvements we’ve made through this transition,” Dr. Schultz said. Jonathan W. Williams, MD, a Burkburnett solo family physi- cian and member of TMA’s ad hoc HIT committee, says EHRs aren’t just a nuisance in medical practice; they intrude into the sacred patient relationship he has spent years nurturing. Dr. Williams does acknowledge EHRs have some beneficial attributes. “We generate good records, can easily flag issues with pa- tients, and our records are well-organized,” he said. Yet EHRs present unique challenges for solo physicians practicing in rural areas. An early adopter of EHR technology, Dr. Williams started using an EHR system in 2002. In the past 11 years, he says he has spent more than $500,000 installing and upgrading hardware and software and paying his vendor monthly fees for tech support. Information technology costs are rising as physician prac- tices adopt and implement EHRs, according to the Medical Group Management Association’s Cost Survey Report: 2013 Report Based on 2012 Data. Since 2008, medical practices’ annual IT expenditures per full-time physician have climbed about 28 percent, from a median of $15,211 in 2008 to a re- ported $19,439 in 2012.
Since he first implemented an EHR system, Dr. Williams says his vendor has either been bought by another company or merged with another company five times. The primary reason he continues to forge ahead with electronic records is due to his participation in the Medicare EHR incentive program. He attested to Stage 1 meaningful use in 2012 and 2013. So far, he has earned an $18,000 incentive payment. TMA has tools and resources to help physicians implement EHRs and achieve meaningful use. The EHR Implementation Guide, the EHR Product Comparison Tool (TMA member login required), the Medicare and Medicaid EHR Incentive Compari- son, the EHR Incentive Program Eligibility Tool, and Medicare and Medicaid incentive program instructions are available on the TMA HIT webpage,
www.texmed.org/hit.
EHR standards needed
The importance of the physician satisfaction study is that it documents what physicians have been saying for years, Dr. Fleeger says. “With this data, we can go to EHR vendors, to the govern- ment, and to quality measurement organizations with proof that physicians aren’t simply averse to change. Rather, physi-
January 2014 TEXAS MEDICINE 19
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