Talk about being stuck in the 19th century. Twenty-eight percent of medical practices still don’t accept credit cards, according to a survey by SK&A Information Services.

True, you’d expect a low rate of plastic payment for some specialists. Only 26 percent of pathologists say they swipe credit cards, but then, they’re usually not having direct encounters with patients, unless they’re deceased.

But get this—only 64 percent of general internists take their patient’s credit cards, even though they’re constantly dealing with $15 and $20 co-pays that could easily be swiped. Family physicians are more automated at 81 percent. The most plastic-friendly doctors are urgent-care specialists at 92 percent. That figure is not surprising since their practices, so dependent on walk-in patients, more closely resemble a retail business than others.

Physicians who won’t accept plastic are financially short-sighted, says healthcare IT consultant Rosemarie Nelson in Syracuse, NY. She says some doctors object to paying a credit-card transaction fee that might amount to 3 percent of a $20 charge, or 60 cents. “What they overlook is that if they have to mail a bill to the patient, it’s costing them at least $3 to $5 in labor and supplies,” says Nelson. “It’s more cost-efficient to take the card at the time of service.” She also notes that fewer and fewer people carry cash and checkbooks with them, underlining the need for a credit-card machine at the check-out counter.

Getting set up for credit-card payments is as easy as calling your local bank, which will walk you through the steps, adds Nelson. For more how-to information, read “Ready, set, swipe” in the Oct. 20, 2006, issue of Medical Economics. SK&A Information Services asked more than 200,000 practices representing roughly 500,000 physicians whether they accepted credit cards from MasterCard, Visa, Discover, or American Express. Practices were not asked if they accepted debit cards. It’s possible that some practices that shun credit cards take debit cards since the transaction fee for the latter is usually lower, provided that the patient enters his personal identification number, or PIN. If a debit card from MasterCard or Visa is swiped without a PIN, however, the transaction rate for a credit card kicks in.

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From Medical Economics magazine, more on billing ...

Internist David Brailer used to be the point man for the Bush administration in its push to build a nationwide health information network. He’s now the chairman of a private-equity firm with more money to invest in healthcare IT—$700 million—than he had at his command back in his federal days.

Those big bucks are hitting the marketplace. Brailer’s firm, Health Evolution Partners, announced on April 28 that it was investing an undisclosed amount of money in an electronic prescribing company called Prematics. Various health plans have rolled out Prematics’ e-prescribing service—including wireless hand-held computers—for participating physicians to use free of charge.

As part of the deal, Brailer will join the Prematics board of directors and hobnob with some other Beltway public servants who have migrated to private industry. Two members of the company’s executive council are former Health and Human Services Secretary Tommie Thompson and former Sen. John Breaux (D) from Louisiana.

Health Evolution Partners is channeling money to Prematics through an investment fund called the Health Evolution Partners Innovation Network. Four well-connected physicians serve as HEPIN advisors: Former Surgeon General and general surgeon Richard H. Carmona, preventive medicine specialist David M. Lawrence, former chairman and CEO of Kaiser Permanente; psychiatrist Arnold Milstein, co-founder of The Leapfrog Group; and preventive medicine specialist Molly J. Coye, founder and CEO of The Health Technology Center.

Brailer headed the Office of the National Coordinator for Health Information Technology, a branch of HHS, from May 2004 to April 2006.

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From Medical Economics magazine, more on technology ...

Certified EHRs are supposed to be the best, and the kind the feds want you to buy, but the number of programs attaining this status has tailed off big-time.

EHR certification is part of the federal push for a nationwide health information network. The US Department of Health and Human Services contracts with a private group called the Certification Commission for Healthcare Information Technology to certify EHR programs that can perform basic tasks such as creating and displaying problem lists, checking for drug interactions, and issuing reminders about overdue tests. The feds won’t let a hospital subsidize an EHR for you unless it has this stamp of approval.

Ninety programs were certified under the initial set of standards that CCHIT issued in 2006. However, CCHIT introduces new and tougher standards each year. That may explain why only 24 programs have been certified so far based on 2007 CCHIT criteria. The organization is still processing 27 applications that came in by the March 31 deadline for certification based on last year’s standards. However, even if all of them are approved, the total number of programs certified as meeting the 2007 criteria would only come to 51.

One key reason for the fall-off is the CCHIT requirement introduced in 2007 for electronic prescribing, says Mark Anderson, CEO of AC Group, a healthcare IT consulting firm in Montgomery, TX. “A lot of vendors don’t have this,” says Anderson, who notes that true e-prescribing is not merely faxing an Rx to a pharmacy, but transmitting it on a computer-to-computer basis. Anderson predicts that vendors will have an even harder time meeting the proposed criteria for 2008, which require EHRs, among other things, to be able to swap patient medical summaries with each other.

Adding such features to an EHR can translate into hundreds of thousands of dollars in programming costs for a vendor. In light of this expense, only the biggest and most well-heeled companies will be able to keep up with ever changing CCHIT criteria. “I think only 27 vendors will be able to pass this next set,” says Anderson.

EHR vendors lacking certified products probably won’t survive in the marketplace, says Anderson, who expects the number of EHR vendors to decline from roughly 390 today to less than 50 in 2012. While a smaller field of vendors simplifies shopping for an EHR, it also will raise prices, he notes.

Many doctors consider EHRs already too pricey. The average cost for nine programs certified under the 2007 CCHIT criteria was close to $30,000 per doctor over three years, according to a recent study by AC Group.

CCHIT spokesperson Sue Reber says another reason for the decline in certified programs is that since certification is good for three years, some vendors in the CCHIT class of 2006 may wait until 2009 before they reapply. Nevertheless, CCHIT is pleased with the number of vendors that have sought certification under the 2007 criteria, says Reber. “Vendors see certification as a competitive necessity.”

[Via Medical Economics’ InfoTech Bulletin]

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From Medical Economics magazine, more on EHR ...

The release last month of the Bush administration’s 2008 National Drug Control Strategy was cause for optimism, but only barely.

On the plus side, the use of illicit drugs among young people has declined 24 percent since 2001, when the first such report was released. The steepest drops have occurred in the use of meth, LSD, ecstasy, steroids, marijuana, and other “street” drugs.

But kids, it turns out, are finding drugs closer to home, sometimes in the family medicine chest. According to the report, prescription drug abuse among the young is on the rise, especially the abuse of opioid pain killers. For youngsters 12 or older, in fact, a pain reliever like OxyContin is now vying with marijuana as the “gateway” drug of choice—the one that initiates even more serious drug abuse down the road. The administration has promised to step up its efforts to control the problem, through youth education and random testing but also through aggressive law enforcement efforts, aimed in part at the prescribers themselves. continues…

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From Medical Economics magazine, more on DEA ...

Cyber attacks on U.S. government computers are mushrooming in number, according to the April 10 cover story of BusinessWeek, and that doesn’t bode well for the security of patient data stored in the computers maintained by doctors and hospitals.

The article, titled “The New E-spionage Threat,” describes how the latest techniques to infiltrate computer networks and harvest sensitive information are “rendering traditional defenses—firewalls and updated antivirus software—virtually useless.” BusinessWeek reports that much of this high-tech spying can be traced back to foreign governments, namely China (which has denied the charge).

Computer spying represents a new form of asymmetrical warfare. “You don’t need an Army, a Navy, an Air Force to beat the U.S,” a US Air Force general is quoted as saying. “You can be a peer force for the price of the PC on my desk.”

Hospitals, doctors, and insurers should be just as alarmed about their own computer defenses.

The New E-spionage Threat [Via BusinessWeek]

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From Medical Economics magazine, more on computers ...

Federal health officials came to New Jersey recently to push a plan that would encourage doctors to adopt electronic medical records as a way of improving patient care, The Star-Ledger reports. Under the government’s five-year demonstration program, as many as 1,200 primary care practices nationwide would receive financial incentives to embrace the technology, Deputy Health and Human Services Secretary Tevi Troy said during a stop at Rutgers University’s Newark campus.

Doctors urged to adopt electronic record-keeping [Via The Star-Ledger]

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From Medical Economics magazine, more on EHR ...

Physicians seeking careers in primary care had as many job offers as specialists for the first time in years, according to the latest survey of physicians finishing training in New York and moving into the work force. Primary care doctors received an average of 3.7 job offers, compared to 2.7 in 2002, the Albany (NY) Times Union reports, based on a study conducted by the Center for Health Workforce Studies at the University at Albany. Job offers for specialists declined slightly to 3.6, compared to 4.3 in 2002.

Primary care doctors find better job market [Via Times Union (Albany, NY)]

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From Medical Economics magazine, more on primary care ...

Private physicians with dropping income have a few options. First, they can take fewer vacations and work longer hours. Second, they can supplement their income by joining the military reserves or the National Guard (this option is less popular lately). Third, they can restrict their practice to patients with higher-paying types of insurance. Fourth, they can market expensive, high-tech services and cosmetic services to this small population of well-insured and high-income individuals. These last two strategies will work in areas with sufficient numbers of higher income individuals, but fails in communities with high numbers of poorly insured individuals. Finally, as physician income shrinks, they look at what they can earn as salaried employees in a large physician group like Kaiser Permanente or Sutter Health Care, or a state institution like the Veterans Home or the state prison system.

Dysfunction within the medical system [Via Napa Valley Register]

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From Medical Economics magazine, more on primary care ...

Benjamin Brewer, a family physician and online columnist, is up to his ears in patients, yet nearly every day he finds himself idled by patient no-shows.Brewer writes in his latest column that a recent study found doctors increase the efficiency of their practice by double-booking appointments, in the same way that airlines oversell seats. Just as a commercial jet flies even when some passengers don’t check in, the “overhead meter for the office keeps running whether patients show up or not.”

Of course, double-booking would mean he’d usually be running late, because most patients do show up for their appointments. Other options have their downsides as well — billing patients for missed appointments isn’t allowed for Medicare and Medicaid patients, and calling to remind patients they’re supposed to come in ties up Brewer’s receptionist.

No-Show Patients Exact a Daily Toll [Via The Doctor’s Office - The Wall Street Journal]

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From Medical Economics magazine, more on scheduling ...

Physicians deserve higher Medicare fees, but they may have to keep enduring annual statutory pay cuts restored at the last second by congressional action, says Neera Tanden, the chief policy director for Hillary Clinton’s presidential campaign. That pattern won’t end, Tanden adds, until universal coverage is achieved. “Hillary has supported the annual increases in pay when they come before Congress and is a strong advocate of better reimbursement for providers. She hasn’t proposed any specific steps to deal with the sustainable growth rate, but believes that universal health coverage will relieve some of the pressure on Medicare and physicians.”

Clinton’s health plan, which she estimates would cost $110 billion a year, would require all Americans to have health insurance. She would pay for the plan by eliminating waste and inefficiencies and rolling back the Bush tax cuts on the wealthy.

Clinton Believes Physicians Deserve Higher Medicare Fees [Via MedPage Today]

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From Medical Economics magazine, more on Medicare/Medicaid ...