HIMSS 2010 – State of Confusion

The annual HIMSS conference and exhibition, which ended nearly two weeks ago, has become a behemoth. In just the past few years, HIMSS grew into a spectacle nearly on the level of the Las Vegas Consumer Electronics Show. According to HIMSS, there were more than 27,000 registrants and nearly 1,000 different vendors – who bought 391,560 square feet of booth space (at over $30/square foot).

Big tradeshow booths are just one sign that the entire Health IT industry is being flooded with money. Is it the HITECH stimulus money earmarked for physicians to adopt Health IT? No, not a penny of the so-called “stimulus money” has been collected by any physician yet.

What I’m talking about is VC money, M&A money, and Wall Street money pouring in from all sides. And why is the “smart money” in America 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 Health & Human Service’s Office of the National Coordinator for Health Information Technology (ONC), the organization at the forefront of the administration’s Health IT efforts – and, as their name implies, the folks responsible for coordinating and informing the public as to the actual details of the plan.

My goal was simple. 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 percent true. I then 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.

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.

First stop, the vendors
Some clear disclosure is in order for those who don’t know me. I am the founder and owner of Amazing Charts, an EHR company whose mission is to provide an affordable and usable EHR to those of us in small practices – so obviously I am biased against the “big boy” EHR systems that I believe use misinformation to unfairly trick physicians into getting gouged. Thus I approached those whom I consider to be “big boy” EHR companies. I spoke to the representatives of a number of these major players in the EHR space, including Allscripts, Athenahealth, Cerner, eClinicalWorks, GE’s Centricity, Greenway, and NextGen, to name a few.

I asked each vendor the same simple question noted above, yet the answers I got from these companies 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. This is despite the fact that each one had sales literature and website pages covered with headlines that misleadingly tout the number $44,000. One vendor’s representative even confused the Medicare and Medicaid subsidies, promising me a whopping $65,000 pay day courtesy of the stimulus money.

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?

Next stop: ONC
Okay, as a taxpaying citizen I figured the government office overseeing all this money should be able to clarify the vendor confusion and provide me some correct answers. In fact, several vendors pointed me to the ONC when my persistent questioning annoyed and/or confused them.

I spoke to five different people at the ONC booth—all of them were Federal officials at one level or another—yet not one of them could answer my simple question.

The first person said “I can’t tell you – it’s more complex than that…” They had to go get someone else. The second person said I would get $44,000 over three stages, clearly confusing the three stages of meaningful use with the five-year period during which physicians may collect incentive payments.

A third person who presented herself as the Director of Communications of ONC said she didn’t know the details, but was sure that the second person knew what she was talking about. Still another ONC rep said, after going to check with somebody from Medicare, that I needed to meet a minimum threshold of $24,000 in Medicare payments before I could collect any money. As an aside he offered that I should increase my Medicare population.

The fifth person said all the information was on the ONC website, but then could not find the information when I asked her to show me. Wrong, wrong, wrong, wrong! Shame on the ONC! Again, who do you think will get the short end of the stick when a physician misled by uneducated ONC representatives spends tens of thousands of dollars on an overpriced EHR?

So what is the reality?
The simple answer, which not one of the five officials from ONC could provide, is that you will be able to collect the lesser of up to 75% of your 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 below.

$18,000 in 2011 (or 75% of Medicare collections, whichever is less)
$12,000 in 2012 (or 75% of Medicare collections, whichever is less)
$ 8,000 in 2013 (or 75% of Medicare collections, whichever is less)
$ 4,000 in 2014 (or 75% of Medicare collections, whichever is less)
$ 2,000 in 2015 (or 75% of Medicare collections, whichever is less)
= $44,000 total 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/year from Medicare, you get less. In other words, the correct answer to my question is that I should be eligible to receive $38,000 so long as I use a “certified” EHR in a “meaningful” way. (Believe it or not, to date there is not one recognized “certifying” body, and the definition of “meaningful use” has not yet finalized. But that’s a blog entry for a different day.)

Rapacious EHR Pricing Schemes
Beyond the alarming inability to get a straight answer from those who should know, there are a few other troubling observations regarding the HITECH legislation that I believe deserves closer inspection.

First, why is it that the head of one of these ludicrously priced EHRs is the President’s Health IT advisor? It would be difficult for any EHR vendor, let alone one whose software (coincidentally?) costs the same as the amount the government is willing to pay, to provide recommendations that benefit physicians and taxpayers over vendors.

Second, and what I see as one of the most flagrant examples of the EHR Industry’s focus on taking every penny of this stimulus money from physicians, is that some vendors told me that their high monthly pricing will drop after the stimulus period is over. There were a few vendors who quoted me a price of $699/month during the stimulus period ($699/month x 12 months/year x 5 years) for a total of $42K. Sounds coincidentally similar to the $44K maximum, no?

Don’t forget – these are our tax dollars. Why should the money be wasted on overpriced EHRs when there are higher-rated solutions available for a fraction of the cost?

There is some good news in all of this. Despite the misinformation from a few of the vendors with whom I spoke, the stimulus money is completely unrelated to the cost of your Health IT expenditures. In other words, physicians who select a more affordable EHR will get to pocket the stimulus money instead of giving it to an overpriced vendor. Better still, each physician who avoids being suckered into paying tens of thousands of dollars to benefit corporate shareholders sends a clear (and long overdue) message to these big businesses: we’re sick and tired of seeing unfair and unethical corporate behavior, and we’re not going to take it anymore!

What do you think?

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