Will Meaningful Use and EHR Incentive Put Medicare in a Bad Position?

In response to Jennifer’s post on Raising EMR in the Meaningful Use era, the always colorful Al Borges, MD provided the following comment:

Ahhh- but John, you’ve never compared EHR/MU to Death! The current Federal Government involvement in HIT is to providers more like the 5 steps of death and dying:

1) Denial and isolation: “This is not happening to me.”
2) Anger: “How dare Obama do this to me! What a jerk!”
3) Bargaining: “Please Obama- just let me continue to survive under Medicare.”
4) Depression: “I can’t bear to face going through this, I’m meaningfully depressed.”
5) Acceptance: “I’m ready to empty my pockets, go into debt, and possibly buy an expensive EHR or just retire… I don’t know. All I know is that I don’t want to struggle anymore.”

I, for example, am perpetually stuck in step 2. I continue to buck the system whenever I can. I’ve actually quit doing hematology/oncology and streamlined my [now] internal medicine practice to survive in these tumulous waters. Result: as more than 60% of the offices next to Virginia Hospital Center [my admitting hospital] have closed and been bought out by the hospital, I’m part of the less-than-40% that have survived. My income for 2011 will most likely show a doubling of my personal gross income.

As I’ve become a “nonpar” Medicare provider, I initially lost many Medicare patients, but I’ve gained what I want now- cash paying and younger PPO/HMO patients to fill in the empty slots. Many Medicare patients now have come back too, because I give them attention and the best care that I can offer. They pay me up-front using the “nonpar” Medicare contractual scale. THEY end up paying the current (s.a. eRx) and future penalties that Medicare will shell out, which is what always happens when big government taxes businesses- the clients end up paying the bill.

Some go through to step 5, buy an EHR, then either deinstall their systems, become hospitalists (or go to another endeavor), or retire. I plan on NOT going through these routes, at least for the next 10 years.

What needs to occur is that the Federal Government has out of HIT. Until that happens, we will never achieve a true “meaningful use” of EHR systems. Yes, doctors will get into inexpensive EMRs (like I have), but they will never buy into something that they cannot afford in both time and money. If EHR/MU continues, you’ll see Medicare suffer as doctors opt out or become “nonpar” making it difficult for the elderly to get the care that they need.

I know that Dr. Borges isn’t the only doctor that has done what he’s done. He’s much more outspoken about it than most, but every doctor I’ve ever met has had essentially the same feeling about Medicare: They hate it. Those that only modestly hate it do so because they realize that currently their livelihood depends on it. Although, even those wish they had a way to get out from Medicare.

While Dr. Borges story is interesting, his last question is the one that I think should be most concerning. Will the EHR incentive money and meaningful use drive many doctors to abandon Medicare and put Medicare in a bad position? One thing I believe goes against this trend is the number of hospital owned practices. I haven’t dug into the economics of hospital owned practices, but I’m pretty sure they won’t have the same flexibility to leave Medicare. I’d love to hear if you think otherwise.

Is Dr. Borges in the minority or could EMR and MU become a real issue for Medicare?

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.


  • I agree with Dr. Borges. He, and many other physicians of like mind, compose the EMR Tea Party — those who do not object to the modernization of record-keeping, but do object to the top-down “carrot-becomes-the-stick” approach to EMR that is being foisted on them. He is a medical John Galt (of Atlas Shrugged), who is more likely to retire or otherwise deny his talents as a “Giver” to society than to succumb to the diktats of the “Takers”.

    Open question: How many Dr. Borges’ will it take before the government is forced to back off (and ideally back out)?

  • Anything government run is typically so fraught with regulatory hell that it usually isn’t worth the insanity. The irony is that the USA touts freedom as one of it’s cornerstone values and then it goes and does something to doctors like Medicare and Medicaid. If the public could only truly comprehend what these things do to doctors. Imagine 300 million people screaming at the government instead of just the few docs out there.

  • I generally agree with Dr. Borges’ statements as well. I was a practicing solo family physician for the past 9 years using a home-grown EMR and seeing the trend where practices have to buy “certified” products with incredible prices that no solo doc could ever afford (especially in primary care) and then to be penalized in 2015 if you didn’t use a certified product, initially drove me to stop seeing Medicare patients. I also know I’m not alone. Although I ended up closing my practice due to declining insurance reimbursements and increasing non-compensated work for the insurance companies, I now feel that I can devote my life to promoting my EMR and see where it takes it. I cannot afford to have my EMR certified, but this is a open-source EMR with an intuitive, simple interface and I’d like to see community involvement in continuously improving the system for all specialties. Anyone interested in helping out? My website to the project is http://noshemr.wordpress.com.

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