David,
Your sentiments are expressed very well, and you do not come across negatively in any way. How could one argue with ?I really believe that the essential value of being a physician is to do something because it is the right thing to do. And, not because it makes money.?? It makes me cringe when doctors express the opposing, self-serving view; sadly, we hear that all too often, usually rationalized by a variety of excuses. I also totally agree with your point about government failure to demand connectivity standards for EMR?s.
Initially I disagreed with your attitude toward MU incentives. Your post has made me reconsider my stance; now I am less sure how I feel. I know I am veering sharply into the philosophical, but consider these two scenarios:
#1: I decide that I really don?t get paid enough by CMS (Medicare) to do a colonoscopy, so each time I do one, I will take a biopsy whether the patient needs one or not. It will take me a little more time, but my payment is increased a bit, and while there is no benefit to the patient, there is really no harm done. Besides, maybe now and then the biopsy will show something that benefits the patient.
#2: CMS comes to me and says, ?We are at Point A with healthcare IT and we want to get to Point B. We know you do not think it will benefit your patients, but we think it will, and besides, there is really no harm done. We also know that it will be expensive for you to do this, and will take some extra time, so if you follow all of our rules and do it ?our way? we will pay you a bit of extra money.?
So #1 and #2 are clearly different. For starters, from a legal standpoint, #1 is illegal and #2 is not. But whereas I always thought that they were very different ethically, now after thinking about your post I am not so sure. Maybe pursuit of payments for actions that we really don?t believe is to our patients? benefit (and which by distracting us from patient care may indirectly be to their detriment) is actually wrong.
