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The Elephant in the Room
By Dana Sellers
I spend most of my time with provider organizations. Recently, though, I spent a day with a company that focuses on payers. As we discussed the many challenges our industry faces in today’s tough economic and regulatory climate, it hit me that we appeared to be coming at the problem from different angles.
One side of the room talked about patients, clinical data, and quality measures. The other side talked about members, population management, and risk reduction. It reminded me of the old story about the blind men who touch the same elephant, but describe it very differently. We were all talking about the same elephant, but we saw it and described it in our own terms.
There’s one thing both providers and payers have in common, though. Everyone’s trying to figure out how to play in a changing world that’s moving toward pay-for-performance, value-based purchasing, and ACOs. Providers are jockeying for position — buying physician practices, networking with community docs, and starting to think a lot more like payers.
Provider CIOs, who are just fully realizing how hard it is to capture the discrete data needed for the first 15 quality measures within their own walls, are facing the challenge of aggregating discrete clinical data over extended provider communities that include a hodgepodge of physician practices, specialty clinics, long-term care facilities, and home care settings.
Key payers are jockeying for position, too. Last week Aetna bought Medicity. Earlier this year, Ingenix, a subsidiary of UnitedHealth Group, purchased Axolotl and Picis. It makes sense that payers want into the HIE world. They need a way to gather clinical data, but more importantly, they want a framework that will allow them to influence the behavior of care providers to drive best practices back out to the point of care. These moves may really complicate things from a provider’s perspective, though.
How all of this will play out isn’t clear by any means, but there are a few things I’d be willing to bet on.
- The 15 quality measures in Stage 1 are just the tip of the iceberg. Over the next five years, reimbursement will be increasingly based on data that must be captured, aggregated, and reported electronically, rather than through abstracting.
- Physicians are key. To enhance the health of a population in a substantial way, you need to be able to connect with community-based care providers, manage handoffs, and influence decisions at the point of care. Whether it’s through acquisition or networking, healthcare organizations need to include physicians in their IT strategies.
- The lines are blurring. Providers are starting to look and talk a lot more like payers, and payers are starting to move into areas long thought to be the domain of providers. We’ll see providers assuming risk and managing populations of members. Interesting alliances and new business models will emerge, and CIOs will need new information systems to support this new world.
- Data will be the new gold in whatever finally emerges out of healthcare reform. Not just clinical data or financial data, but both combined … and lots of it. Payers have known this for years, and have invested heavily in systems to capture and report on member data. The organizations that come out on top will be the ones that figure out how to capture data, how to aggregate it, and how to apply the insights they derive from it to bring about real changes in quality. This doesn’t happen overnight. CIOs who don’t take the time to develop an analytics strategy will struggle to keep up.
So maybe at the end of the day, it doesn’t matter so much that we all have the same pachyderm perspective … as long as we can get it to do the heavy lifting.
Dana Sellers is CEO of Encore Health Resources of Houston, TX.
I Have an ONC-Certified EHR and Vendor Meaningful Use Guarantee, Why Do I Need Anything Else?
By James O’Connor
Software is a tool. An ONC-certified EHR captures and reports data, but an EHR system cannot characterize the gaps in your workflow and processes, initiate change within your practice, or foster teamwork to meet a common goal. These activities can be supported by a good software tool, but cannot be enacted by one. Here’s an illustration.
Recording demographics is a core requirement. To an EHR vendor, "readiness" means there is a form somewhere in the system that collects the information and there is a report that calculates the ratio.
To a medical practice, "readiness" means something else entirely. Certainly demographics are being recorded to some extent now, but one of the Meaningful Use requirements is to record a patient’s preferred language. To comply, practices must update forms (if patients still register on paper) and train staff to ask established patients the question (to fill in the gaps).
There is no partial payment for partial compliance. If the ratio doesn’t hit the minimum 50%, there will be no incentive payment. There are a number of requirements that depend on staff, not clinicians, to fulfill. These must be understood and incorporated into the workflow.
It is no great secret that Meaningful Use (at least Phase I) is not rocket science. The steps to prepare do require organization and a certain depth of knowledge. A small- to medium-sized practice willing to dedicate a competent individual to undertake this task can reasonably expect the person to succeed.
It might take a little longer. There may be a few bumps in the road dealing with the HIPAA security assessment. There could be some resistance to change if the individual selected to head the effort has a "regular" job that does not ordinarily have the power to influence senior members. But surely it can be done.
On the other hand, there are benefits to bringing in an outsider: no subtraction from practice productivity, no power struggles, no learning curve, greater objectivity, expertise with security assessments. Also, you can fire a bad consultant, but dealing with a staff member who isn’t performing can be touchy.
Regardless of the path chosen, be sure to read the EHR vendors’ guarantees closely. They generally offer to credit the monthly usage or maintenance fees for a limited period of time if the practice doesn’t receive the incentive payment. Practically speaking, how will that work?
The incentive is paid to individuals, but fees are typically paid by the practice. Does that mean if one physician does not qualify, then there are no fees for the entire practice that month? Does it mean that a portion of the fee will be credited?When you really think about it, what is a monthly maintenance fee compared to $44,000?
Yes, you need an ONC-certified EHR system, but don’t depend on an EHR vendor’s guarantee to get you ready.
James O’Connor, MD is CEO of MDcohort of Ashburn, VA.
Electronic Medical Records, HITECH, and Your Health Information: Does Bureaucracy Inhibit Innovation?
By Doug Wallace
In case you have not heard, the economic stimulus program that passed in 2009 includes a little something called the Healthcare Information Technology for Economic and Clinical Health (HITECH) act, funded in excess of 20 billion dollars.
Your doctor is now required to computerize your personal health records. All of them. Boom!
Gone will be your current paper medical charts. But where will they go? Scanned and computerized for easy access and review. And why?
The current administration has claimed that, “To improve the quality of our healthcare while lowering its costs, we will make the immediate investments necessary to ensure that all of America’s medical records are computerized”.
While productivity and efficiency is a necessary goal, who is to decide how to accomplish such an initiative?
Much as the Transportation and Security Administration (TSA) claims that upon purchasing a ticket for air travel, you may well than “give up a lot of rights”. Will this hold true for your medical information?
In the move to enforce compliance of HITECH and physician adoption of electronic medical records, some immediate barriers to this initiative have become evident. Among them: doctors are not moving as fast as the money is flowing; the healthcare market already is positioned to deliver on what HITECH demands; any “preferred EMR systems” in good favor of Health Information Exchanges (HIEs) would hinder free market choices.
Is it fair to use regulation as a way to bypass legislation? Or just let bureaucrats decide? The US healthcare system is approximately 2.5 TRILLION dollars, or 18% of the GDP. Should measures such as our personal medical information be placed on a relative fast track whose journey has just begun, for an outcome that is uncertain?
Doug Wallace is executive VP, business development solutions for My EMR Choice of Doylestown, PA.