Editor's note: The following letters are in response to an opinion piece, “Should Doctors Reject the Government's EHR Incentive Plan?”, which was published online in advance of the print issue.

I appreciate Dr. Kibbe's honest assessment of the mood of private-practice physicians with regard to the electronic health record (EHR) incentives. We bought an EHR in 2002 and have spent tens of thousands of dollars over the years to make it fully integrated and operational. We purchased an order-entry module to qualify for the designation of a medical home and planned to purchase the last piece of software in the package, which would allow us to e-mail patients and make appointments online.

I have been an enthusiastic supporter of the concept of the medical home, which necessitates the use of an EHR. I have seen firsthand the benefits of outcomes tracking, as it has made an immediate difference in our practice.

For two years we participated in Medicare's Physician Quality Reporting Initiative. We never received the bonuses, and worse yet, we have been unable to determine the reason. My office manager and billing consultant have spent hours trying to speak directly to someone about this. Most of the people at the Centers for Medicare & Medicaid Services don't seem to understand what we're requesting, and when we finally found someone who did, they acted as if it were a state secret! We have been waiting to receive an e-mail with the information about why we were denied, but after two weeks and no word, we will have to begin another round of phone calls.

I am skeptical, just about cynical, and fed up! I don't believe the EHR incentive payment will ever find its way to my practice because we are small and insignificant. As you know, the insurance conglomerates made that clear long ago. I thought we had a friend in the White House, but I realize that one administration cannot reverse the course we are on any time soon. I am now ready to abandon the medical home, the order-entry module, the online scheduling and patient e-mail module, and much of the software obligations I have carried for eight years.

I agree that with the prospect of declining reimbursement from private insurers, the potential boost in Medicare reimbursement doesn't nearly recoup the increasing cost of technology for the small, private family practice. I am convinced that the EHR incentive plan has been transformed into another gift to “corporate” medicine.

Bravo! If a private practice wants to adopt an EHR because they think it is a good idea, go ahead; just don't count on the government's EHR incentive plan to materialize. Finding an EHR that suits you and your practice is more important than finding one that meets the plan requirements.