A recent study involving 60 interviewees revealed that the documentation focus of current ambulatory EMRs supports billing and not patient needs. Researchers at the Center for Studying Health System Change (HSC) concluded that the current reimbursement system drives EMR use for documenting billable services over care coordination, the opposite of what policymakers wanted.

Can we solve this problem and change the course? Yes, but not without real disruption, a real healthcare revolution, namely payment reform. It sounds easy enough. Pay for care coordination rather than pay for volume of services. You hear it enough times at conference keynote speeches. So why is it so difficult to do?

There's money to be had with the pay-per-volume model. You can save money with care coordination, but can you make a living out of it? A number of studies have been coming out recently validating the patient-centered medical home model's claims of improving the quality of healthcare and being cost-effective. So now we have to tie reimbursement to quality metrics. And once you tie reimbursement to quality metrics, providers will use their EMR systems to document quality metrics and care coordination. They're still documenting for the purpose of billing, but they’re also documenting improved care.

CMS began a Medicare Medical Home Demonstration in 2008 but curtailed it because healthcare reform legislation would impact it. The plan going forward is to replace it with an Administration-initiated demonstration. The purpose of their original medical home demonstration is to determine whether they reduce costs and improve the quality of healthcare. CMS created a formula for payment, but I wonder if using the Medicare physician fee schedule (for fiscal year 2009) is flawed. Yes, you’re adjusting the payment, but you’re adjusting it off of a flawed schedule. Bottom line: CMS is missing an opportunity to align the medical home concept with payment reform.

We need major payment reform. Once payment reform is enacted, the next-generation EMRs and providers will conform to a transformed healthcare system.

Easier said than done, of course.