'Age is just a number' -- Does it hold true for EHR adoption?
Older physicians are less likely to use an electronic health record system than their younger counterparts. A recent Health Affairs study found that in 2011 30.8% of physicians older than age 55 were using a basic EHR system, compared with 40% of doctors younger than age 40 and 35.5% of doctors ages 40 to 55.
There are several reasons for the lower EHR adoption rates among older physicians. Some older physicians might not be as technologically savvy as younger doctors and thus are reluctant to transition to an electronic-based workflow. In addition, older physicians are more likely to work in solo or small practices, which face greater financial barriers to EHR adoption. Further, some older physicians say they'll be ready for retirement by the time they start to see any return on investment from EHR adoption.
Currently, older physicians who use a paper-based record system are not eligible for Medicare and Medicaid incentive payments under the meaningful use program. And, beginning in 2015, physicians who cannot demonstrate meaningful use of EHRs will be subject to a 1% reduction in Medicare payments. That penalty will increase by 1% in each subsequent year, eventually reaching 5%.
Push for a Hardship Exemption for Older Physicians
Arguing that older physicians face unique barriers when it comes to EHR adoption, some groups are pushing for CMS to include a hardship exemption category in the meaningful use program for doctors who are close to retirement.
In its comment letter to CMS on the proposed rule for Stage 2 of the meaningful use program, the American Medical Association called for an exemption for physicians who currently are eligible or will be eligible by 2014 for Social Security benefits.
AMA wrote, "It would be economically burdensome for physicians who intend to retire in the next several years to purchase, install and meaningfully use an EHR." It added, "We are also concerned that many of these physicians may decide to close their Medicare fee-for-service panels or opt out of Medicare to avoid penalties during the end stage of their clinical careers, which would adversely affect access to care for our nation's elderly and disabled."
An AMA policy expert said that EHR adoption is a significant investment both in terms of cost and time and that older doctors likely won't be practicing long enough to realize the benefits of health IT, such as improved patient care and efficiency.
She said that if a physician plans to retire within five years, it probably doesn't make financial sense to invest in an EHR system.
Without a meaningful use exemption for older physicians, such doctors could close their practices prematurely or limit the number of Medicare beneficiaries they treat, according to the AMA policy expert.