Electronic Health Records, Inflation, and Private Medicine.

• Author: Goldman, Devorah

In late 2021, doctors and medical students bombarded Congress with hundreds of thousands of letters protesting a scheduled 10% cut to Medicare payment rates for private physicians. The effort, largely organized by the American Medical Association, was rewarded, and doctors were granted a reprieve from the full reduction, but physician payments are still being trimmed just as inflation has hit a 40-year high. Physicians are also facing a statutory payment freeze scheduled to last through 2026.

In some ways, this marks a pivotal moment for private physicians. Unlike other small business owners, doctors running private practices have little power to set their own prices; Medicare largely sets the going rates for the entire industry. But the costs of running a private medical practice rose by around 39% between 2001 and 2021, even before the recent inflationary spike. Related expenses include office rent, employee wages and benefits, costly medical equipment, malpractice insurance premiums, and so forth. On top of that, a study published in JAMA Health Forum estimates that it costs $12,811 and takes more than 200 hours per physician annually to comply with the Medicare Merit-Based Incentive Payment System (MIPS).

EHRs / What is MIPS and why should it cost doctors so much? First approved by Congress in 2015, the system is designed to push doctors to improve the "quality and value" of their services. More than anything, it seeks to nudge physicians to use electronic health records (EHRs) in their daily work. This has proven to be costlier and more onerous than policymakers anticipated.

Beginning in 2017, hundreds of thousands of physicians across the country were forced to participate in MIPS or else face severe financial penalties. Today, Medicare increases or decreases payments to doctors based on how well they perform on a range of complicated EHR-related measures.

MIPS is just one of several major government initiatives to get doctors to adopt EHRs. The controversial technology systems were originally optimized for billing --rather than actual medical care--and they have been widely lambasted. In 2019, Fortune magazine and the Kaiser Foundation released a bombshell report, "Death by 1,000 Clicks," on the thousands of serious, sometimes fatal, medical errors caused by EHRs. Some of the problems are features rather than bugs.

Because of the enormous quantity of data that EHRs require doctors to fill in per patient, the report explains that...