As I completed my initial read of the 856-page final rule, I found one provision (or lack thereof) in both the initial and final versions of the rule that I believe will have negative consequences for the implementation of the program. If my reading is correct, physicians who practice pediatrics or a pediatric subspecialty will receive no incentive for implementing and utilizing an electronic medical record unless Medicaid patients account for 20% (nonrural service areas) or more of their practice or unless they see as patients children who are eligible for Medicare as the result of being totally and continuously disabled.
I understand the relationship between infant mortality and inadequate healthcare, and I am struck that we have failed to develop a program that will incentivize the use of EHRs to enhance the quality and safety of care for ALL children. Perhaps this is because the puzzle of how the wealth of a country, its healthcare focus, and infant mortality fit together is more difficult to understand. According to the CIA World Factbook, our per capita GDP at $46,400 is exceeded by only 10 other countries. Yet at a ranking of 180 in the world with respect to infant mortality, there are 44 countries whose rates of death per 1,000 births are lower.
Interestingly, four of the 10 countries whose per capita income average is higher than that of the United States also report higher rates of infant mortality than those for U.S. babies. Perhaps for these higher per capita income countries the manner in which wealth and healthcare are distributed is different than ours. Perhaps it is one of many other factors that interact in a manner that I simply do not understand. Nevertheless, by limiting the incentives necessary to bring needed technology to bear on the care of all of our children, in the long run we do ourselves a disservice as a nation.
Ridgewood, New Jersey