EPtalk by Dr. Jayne 6/5/25

As one might expect, the hot topic around the virtual physician lounge this week was the accuracy of the “Make America Health Again” report, which appeared to be at least partially co-authored by some unsupervised AI. The report exaggerated findings and cited studies that were nonexistent. As someone who has spent countless hours serving on the conference committees that review scientific findings and knowing how hard actual scientists and researchers work, it’s particularly offensive. The report doesn’t even have listed authors, which is telling. I wouldn’t accept bogus citations from the first-year undergraduates when I was a teaching assistant for “English 101: Thinking, Writing, and Research,” so it’s incredibly difficult for me to see this kind of thing happening among our nation’s leaders.

The physicians I work with are fed up with what they are seeing come out of CMS and the Department of Health and Human Services, knowing that not only do public health interventions such as vaccines or fluoride in the water supply reduce morbidity and mortality, but that they are also cost-effective. For those of us who have spent our lives in the pursuit of evidence-based treatments, improved outcomes, and careful spending on patient care, the cognitive dissonance we feel is profound when patients bring this pseudo-science into our exam rooms. We’re tired of being told that we’re “in the pockets of big pharma” and that we’re making money off of vaccines – neither of which is farther from the truth for the average primary care physician. It’s almost as bad as the cognitive dissonance we felt during COVID. If I were seeing patients full time right now, I doubt I’d be able to make it through a full day of clinic. I have the highest respect and gratitude for my clinical colleagues who do it every day and it makes me want to work harder to support them in whatever way the informatics team is able.

I had a chance to speak with some of my favorite EHR folks today, and we were talking about the challenges that hospitals and health systems will be facing in the next few years. Everyone seems to be struggling financially and looking for ways to reduce expenses because of the difficulty of forecasting income these days. It’s difficult to fine tune your assumptions if you don’t know whether there will be Medicare cuts, Medicaid cuts, or changes in how commercial insurance companies are paying due to changes with the first two. There are still concerns about telehealth payments, coverage for remote patient monitoring, and the ability to cover costs for other services that can drive the needle for health outcomes long term, such as weight management programs and preventive services.

Managing human health is a long game, with things that happen to us in childhood potentially driving health outcomes decades later. Since many of the players in our system are more concerned about generating profits for investors and shareholders on a quarter-to-quarter basis, it seems less common for organizations to consider taking less profit on a quarterly or annual basis in order to play a much longer multi-year game. There are also so many complex forces at play when you consider health outcomes, from access to high-quality food to the availability of preventive services. I remember back in the day when we struggled to care for patients with diabetes because Medicare wouldn’t pay for diabetic testing supplies until the disease reached a certain severity. Sure, test strips are expensive, but so are amputations and dialysis services, and it took years to get those coverage decisions amended.

I look at the IT budgets of some of the health systems I’ve worked with over the years, and on the surface they seem insanely high. However, when you look at the number of things we’re trying to do now using technology, it’s easier to understand. There are so many more technology workflows in the average patient’s care now – from online scheduling to contactless check-in to online bill pay and beyond. We have automated medication cabinets rather than candy stripers running medications down the hall on carts (which is actually how I started my clinical career, back in the day). We are trying to reach patients on so many more levels – from pre-visit education to in-visit technology support to post-encounter care, and we never did those things before. They all cost money, but technology isn’t necessarily to blame. They’d cost significantly more if we were trying to conduct those same workflows with humans.

I certainly don’t envy my CMIO and CIO friends who have been told to cut budgets across the board without regard to how those cuts are going to change outcomes and potentially impact patients. My generation of physicians is seeing quite a few early retirements and I fear that more will be on the way as organizations try to trim salaries by making it more difficult for physicians to make the same amount of money. I see plenty of hospitals that are being penny wise but pound foolish in how they are managing staffing models for nursing and ancillary services. I can’t help but think it is going to get a lot worse before it starts to get better. I’d be interested to hear how healthcare leaders are approaching those arbitrary budget cuts. I think I’d be tempted to bring out the Magic 8 Ball as I was assessing line items, just to bring a bit of levity to a difficult situation.

Mr. H shared this photo earlier in the week, and I cringed at the disingenuous caption. Anyone who thinks that caring for patients after a cyberattack is “caring through the unexpected” is delusional. Call me cynical, but we should all be expecting this, every single day. Hackers are getting more sophisticated every day and it’s only a matter of time before an organization gets hit. If you haven’t refreshed your downtime plans or had a drill recently, it’s time to do both.

I would be remiss if I didn’t say, “Happy Birthday, HIStalk!” since everyone’s favorite healthcare IT rumor mill began around this time in June 2003. Those were interesting times, when organizations were rolling out technology because they wanted to improve patient care, reduce physician documentation burdens, and save a lot of trees. Fast forward, and although we’ve met some of those goals, we’ve made others worse. Here’s to seeing what the next two decades of healthcare IT throws our way.

Do you have a favorite HIStalk memory? Leave a comment or email me.

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