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March 9, 2009
by vciotti
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Why don't most admitting doctors use hospital CPOEs? Because computers take longer than scribbling on an order sheet, and they want to get through rounds as quickly as possible to get back to their office and try to make some money. The CPT codes for hospital "Encounter & Management" (the E&M codes in the 7000 series)) pay pathetically small amounts compared to what they can bill for that line of patients lined up in examining rooms back at the ranch...

Yes, there are many other reasons they should use CPOE, like better patient care, improved quality, less work for nurses, etc., but that benefits everyone else but them! Yes, there's the Hippocratic oath, but aren't we all hypocrites for taking our big-buck white-collar salaries while asking them to do something for free for the public benefit?

So what to do? Create a new E&M code for e-CPOE, that is, a little kicker (around $20 or $40) that a physician can bill above and beyond the existing E&M codes, to reimburse docs for taking the 5 minutes or so it takes to navigate the anal sign-on screens, programmer-designed menus, mind-numbing alerts, etc. of a CPOE system. The few extra hundreds of dollars a day might be just enough to motivate them to learn the system, after which they'll recognize its benefits first-hand (e.g.: less calls from nurses and pharmacists about generic drugs and their rotten handwriting).


So is anyone in Washington listening?



I'm listing Vince and I totally agree. In one way or another, it's going to be P4P that carries the day. As I've written before, it's ludicrous to assume physicians are motivated by anything other than what applies to the rest of humanity.

As a physician implementing CPOE at a large Institution, design is key to making it work, by developing order sets, turn-off useless alerts, rapid cycle quality improvement. The unit that we have that are closed loop medication, the physicians, the nurses, would not go back to paper, once they got over the learning curve they love it.
Companies need to invest more in physician who design interfaces,

I'm listening, too.

Would you propose that payers reimburse doctors directly, pay-for-use, through CPT codes for their inpatient use, or should the payments flow through the hospital (running the CPOE system -  the hospital and doctors directly aligned to make a system work)?

I've certainly seen multiple examples of where hospitals have paid physicians for using CPOE. This was done for exactly the reasons you described and has been very effective.