Posted: July 7, 2012

Dr. Stark has insinuated himself into the broad area of Medicine and Public Policy. He published a piece in the Annals of Internal Medicine about the role of the electronic medical record (EMR) in health-care reform. The original article appeared in the Annals written by Chaudhri of UCLA Medical School (AIM 144:742, 2006). Chaudhri reviews many prior studies and concludes that the use of the EMR improves the quality and efficiency of health care.

The Bush administration weighed in on this by promoting a “pay-for-performance” standard in health care. In other words soon doctors may receive enhanced payments from Medicare and Medicaid if they are “better” doctors. One of the ways “better” will be measured is whether they have implemented an EMR in their office. The Obama administration is moving ahead to implement the EMR throughout health care.

Dr. Stark, in his comments in the Annals, calls forcing doctors to use the EMR to maximize reimbursement another unfunded government mandate. (click here for the link if you have a subscription). Small practices are already struggling to survive — especially those of Family Practitioners and Internists — and to ask them to come up with several hundred thousand dollars to comply with this new mandate is unreasonable in his opinion. The government threatens to push the issue by creating a two-tier reimbursement schedule, for those who have an EMR versus those who do not. More doctors than ever will be forced not to accept new Medicare and Medicaid patients, just to survive, under this scenario. Or they will be forced to sell their practices to a large health care consortium, much as Dr. Stark was forced to do in 2008.

Public officials are convinced that the EMR — to include a more efficient interface between the office record and the hospital record — would make for better patient care. Not all doctors agree and some point to a paucity of data on improvement in outcomes with EMR implementation. How to fund this implementation remains an issue.

The implementation of the EMR has recently received a boost from Congress in its allowing hospitals to provide the EMR to its staff physicians at a huge discount to retail prices.  Previously this would have been seen as incentivizing self-referral and would have been subject to civil and possibly criminal penalties.   The next issue is how the roll-out will affect health care.  A number of authorities worry about how narrative in medicine will be affected by the copy-and-paste approach to record keeping built into the EMR.  The pitfalls of the EMR have been addressed further in a recent observation that an upgrade to the Veterans Administration EMR (widely regarded as the most thorough and best implemented in the industry) resulted in the wrong patients’ records being downloaded.

Dr. Stark was recently interviewed by Health Care Finance News on the subject of the death of the solo oncology practice.  He came to their attention through COA (Community Oncology Alliance) an interest group for private oncology practices.  He told his story of how he was forced out of solo practice by the changing economic environment.  Click here to read the online version of the article.