EHR Q&A: Is EMR or EHR a Requirement

Brenda asked:
As a private OT clinic that does not contract with medicare/ medicaid, are we required to use electronic medical records? We do submit claims to private insurance companies electronically.

Answer:
The short answer is no.

In fact, NO ONE is REQUIRED to use EMR whether they take Medicare or Medicaid. However, if you take Medicare or Medicaid, then you have to be a “meaningful use” of a “certified EHR” in order to: 1. Get the EHR Incentive money and 2. Avoid the government penalties for not being a meaningful user of an EHR.

Some might argue that the work to show meaningful use is not worth the effort compared to the incentive money you receive. Plus, the penalties for not using an EHR are not that big of an issue (see this post on the EMR penalties ) Although, there are plenty of people arguing on the other side. For example, Meaningful Use is relatively easy (at least in Stage 1) and the penalties are going to be a major issue for their clinic since they have such a large Medicare or Medicaid population.

Then, there are the doctors that are leaving Medicare and Medicaid behind completely (see this doctor as an example). The argument here is that Medicare and Medicaid are the lowest paying payers out there and now they’re going to penalize them even more so they might as well just stop taking them. We’ll see how many adopt this strategy.

One word of Caution…
There’s a possibility that insurance companies will hop on board the requirement of an EHR and Meaningful Use (see this post about private insurance and meaningful use ). I’m sure they’re keeping a keen eye on how well it goes for the government before making any decisions. My gut feeling is still that they won’t wholesale take the governments approach to EHR and meaningful use. Instead, they may require some sort of electronic documentation or reporting requirements which are more easily performed with an EMR. Essentially it will be an extension of their requirement to have claims submitted electronically.

Despite the myth that EMR is a requirement, so far no one can require you to use an EMR. They can only provide incentives and penalties if you don’t (which only the government has done to this point). Although, there’s always the aspirational goal that Bush and Obama have made of Full EHR by 2014.

The longer answer is…EMR is not a Requirement….yet?

Be sure to check out all the EMR Stimulus Questions and Answers posts.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

5 Comments

  • “Required” is such a strong word.
    It it probably more correct to say, you will penalized by lower reimbursements, etc (at some point) if you are not electronic…that being said with the same caveats above on the two M’s.

    Of course, this may vary by your medical organization.

    Locally, our major medical organization required all physicians go EHR. They didn’t “force” a specific EHR on everyone, but they made it quite difficult if you didn’t use “their” EHR.

    It’s not required, but lower reimbursements will occur if you don’t use it.

    Something else to consider: If you might me selling your practice in the near future (5 – 10 years??) – don’t you think the value of your practice might be higher if you are on an EMR?

  • There shouldn’t be a “requirement” to go with an EMR, but there are very strong reasons why practices should want to be on one. If there was ever an industry MORE in need of a communication transformation, it’s healthcare. They shouldn’t have to be bribed to do it, and then blackmailed if they don’t. Let’s put MU aside for a minute and look at the other benefits: demographic reporting, trend spotting, pandemic prevention, virtually wipe out over prescribing, scrip errors, and scrip forgery… and maybe, just maybe reduce addiction rates to meds and maybe, just maybe slash access to pills for our children. Depending on your payers: steep reduction in M/M administrative costs, improved billing rates to the providers, reduction in M/M fraud, and perhaps reduction in malpractice suits.

    There has been a tsunami of failed implementations that has many physicians and practice managers afraid to take this on. I have found the real culprit to be misinformation. You can’t turn the lights off on Friday and expect on Monday to transform the way the you practice medicine because it is not as simple as putting a CD in the tray, downloading software and following the tip-wizard. It is human nature to listen to the stories of failure, than those of success. It’s just juicier… we love failure in America.
    As for MU, The fed is giving $44K to each provider, Software and Hardware can range from 15K to $20K per provider. That leaves up to $30K left over. That was not intended to be a gift or a reward, it was intended to pay professionals to help them implement.
    No disrespect intended but the office manager or practice manager is not qualified to manage an implementation… unless they’ve done a few before. First instinct is to blame others. And blame they do! At conferences, on blog-sites, by the water cooler… fear and panic spreads and we all know the grapevine theory..once again. Misinformation!
    My position as a physician’s advocate exposes me to a tremendous amount of misinformed people. There is a great deal of valuable information out there that the physicians need exposure to. However, the information flow stops at the front desk. If “information is power” that means the lowest paid person in the office has the most power.
    If they were truly informed, they wouldn’t even consider this a “requirement”. They likely will have successfully implemented by now

  • Jab,
    I’ve considered the idea of whether an EHR in your practices raises the value of your practice. I guess I can see some arguments that could go either way with it probably leaning towards being better to have an EHR.

    !Phisherman5,
    It’s interesting that an industry that’s all about “caring” for patients has such a hard time sharing even though we all know it’s the best thing for the patient’s care.

    I’m not sure that they always need a professional. Some practice managers are capable of an EMR implementation, but most are likely not and will need help. Not to mention, many of them are so busy running the practice.

    There’s definitely an information gap. That’s one of the goals of my independent network of EMR related sites.

  • I don’t think that Medicare is the lowest payer out there, trust me there are worse ones. But there is such a regulatory mess and threats of payment reductions for all we do for Medicare patients, who sometimes deserve twice the pay when all the work is done, that it becomes a losing situation for the modern doctor’s office, unless one wants to bury their head in the sand and talk about all the great duties we have as doctors.

  • Michael,
    I just report what others tell me about where Medicare lies;-) Bureaucracy and red tape are very expensive.

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