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Decision 2012: Doctors Fight Over Obamacare Provision

Monday, 5 Nov 2012 | 3:52 PM ET

Republican Mitt Romney has promised that if he wins the White House, he will derail the Affordable Care Act, aka Obamacare. As he and the President debate the costs and benefits of providing healthcare to all, behind the scenes, one part of the new law is being fought ferociously by many doctors — the mandatory move to electronic medical records.

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Moving health-care records into the cloud would streamline the communication of information between doctors and hospitals about a patient's health history, potentially saving time, money, and lives.

So why are so many healthcare providers fighting it? They say the current solutions don't save anything.
(Read More: Cloud Computing 101)

"It certainly has its pluses," says Ken Smithmier, President and CEO of Decatur Memorial Hospital in Decatur, Illinois. "But it definitely is not any kind of magic answer to much of what ails health care today." (Read More: Prepping for Obamacare, Chain Cuts Workers' Hours)

The government has been providing financial incentives to transition paper records to electronic, and many practices are taking the money and then trying to figure out what to buy. Smithmier said his hospital received $3 million in government funding to help purchase a system by McKesson which he estimates will cost a total of $100 million. The equipment involved is expensive. He says a radiology terminal, which converts X-rays to an electronic record, can cost as much as $60,000. "We're not talking about some Dell thing."

Besides McKesson, other companies selling electronic systems are Epic and Cerner. The problem is there is no compatibility between them. A doctor using Epic can't send his or her records to a hospital using McKesson. "That's the rub," said Smithmier. "The incompatibility issues are huge." Even within a hospital group using one system, Smithmier noted there can be compatibility issues, as each hospital tweaks the software for its own doctors and nurses. He believes the only solution is a mandated set of standards.

Many doctors in private practice are exasperated. "You're going to see a lot of doctors retire early," warned one frustrated dermatologist who spent $100,000 on an electronic system he says "doesn't work." (Read More: Candidates Make Final Pleas as Legal Fights Begin)

The problem for doctors is if they don't have an electronic system in place by 2015, they'll see a reduction in their Medicare payments. The California Medical Association has come out opposing financial penalties for physicians who do not adopt the new technology.

"I'll probably pay the penalty," said Dr. Sam Fink, an internal medicine physician who heads the Los Angeles County Medical Association. He's checked out several different electronic options. "Everything is very busy and involves a lot of mouse clicks." He said this cuts into productivity and time with patients. That's lost money and less care. What's more, Dr. Fink noted the final product after all those mouse clicks isn't impressive. "It comes out very generic like a form letter from the government, and it doesn't tell me very much about the patient." (Read More: Wealthy Work to Avoid Health-Care Law's 'Mini-Cliff)

Smithmier, the hospital CEO, believes some doctors will move from private practice to a hospital group like Kaiser, which already has a system in place. Dr. Fink agreed. Already, younger doctors coming out of medical school seem less interested in starting their own practices with all the overhead and regulations, and more interested in the work-life balance they get working for a large group or hospital.

That's not to say there aren't good things about electronic records. "A fully computerized doctor's office can find all patients on a drug that a recall notice is issued for," said Smithmier. "They can do a search — let's say for all women over age 50 — who haven't had a mammogram in the last 12 months and then send a reminder." However, he said no one should be fooled into thinking the conversion to electronic will save money. "There is no return on investment in this stuff. I simply view it as being like roofs and boilers and parking lots, just something you need to do these days as a cost of doing business."

Dr. Fink plans to see what happens with the election and with the pace of enforcement. "I'm just sitting at the poker table waiting," he explained. "I don't need to make a move in any direction yet."

—By CNBC's Jane Wells
@janewells

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