John Halamka, CareGroup Health System, Life as a Healthcare CIO
John D. Halamka, MD, MS, is CIO of the CareGroup Health System, CIO and Dean for Technology at Harvard Medical School, Chairman of NEHEN, CEO of the MA-SHARE RHIO, Chair of HITSP, and a practicing emergency physician. He blogs at Life as a Healthcare CIO.
Healthcare IT Implications of Healthcare Reform
December 9, 2010
I'm often asked how Healthcare Reform will impact IT planning and implementation over the next few years.
First, some background. The Patient Protection and Affordable Care Act (HR 3590) and Health Care and Education Reconciliation Act (HR 4872) were passed to to address several problems with healthcare in the US. We're spending 17% of our Gross Domestic Product on healthcare, yet we have worse population health outcomes than many other industrialized societies spending half as much. Healthcare costs are rising faster than inflation. We have significant variation in practice patterns that is not explained by patient co-morbidities nor justified by comparative effectiveness evidence. We want to expand access to health insurance to 95% of the population, lower our spending growth rate, and incentivize delivery system change.
How will we do this?
Health insurance reform expands coverage, makes features and costs of plans transparent, and removes the barriers to enrollment created by pre-existing condition considerations.
Payment reform transforms the Medicare payment systems from fee-for-service to Value Based Payment - paying for good outcomes rather than quantity of care. Pilot projects will test new payment methods and delivery models. Successful innovations will be widely implemented.
Let's look at the payment reform details that will lead to delivery system reform.
Medicare Initiatives include
- Medicare shared savings program including Accountable Care Organizations (ACOs)
- National pilot program on payment bundling
- Independence at home demonstration program
- Hospital readmissions reduction program
- Community-Based Care Transitions Program
- Extension of Gainsharing Demonstration
Medicaid Initiatives include
- Health Homes for the Chronically Ill
- Medicaid Community First Choice Option
- Home and Community Based Services State Plan Option
- Hospital Care Integration
- Global Capitation Payment for Safety Net Hospitals
- Pediatric ACOs
I believe that Accountable Care Organizations will be the ideal place to host several of these innovations including bundled payments, the medical home, and an increased focus on wellness.
All of this requires innovative IT support.
Here are my top 10 IT implications of healthcare reform:
1. Certified EHR technology needs to be implemented in all practices and hospitals which come together to form Accountable Care Organizations. EHRs are foundational to the capture of clinical and administrative data electronically so that data can be transformed into information, knowledge and wisdom.
Dr Duncan say: Healthcare IT Implications of Healthcare Reform
Dr Halamka,
I agree that there is room for improvement in medical care in the United States and that IT and the EMR can help with the effort.
However, there is a danger of interfering with individual doctor’s ability to provide care for their patients with the associated increase in demand for data input by the doctors or the increased cost of adding staff to input the data required for measuring quality and "value." You must consider the impact that the demands for increased data have on physician’s practices.
The plan you describe is in keeping with the popular catch phrase "leveraging health IT infrastructure." But this also leveraging the good will of physicians who have already been pushed to their limits of tolerance by the demands of government and the government’s incompetence regarding reimbursement methods. In the business world, leveraging means using money that does not belong to you to invest and make money. The government's use of the IT infrastructure is using time (doctor’s time) that does not belong to the government. Doctors are becoming increasingly intolerant of this. I see this as a physician EMR facilitator in our 110 multispecialty clinic where we are trying to use the EMR to achieve "meaningful use." Most doctor's office run very lean. Everyone is busy doing something. Unless data entry generates revenue equivalent to revenue from treating patients, the extra time or staff for data entry becomes very costly and an imposition produced by "leveraging" IT structure.
The following is a message I sent to the Quality Measures Workgroup yesterday in response to their request for comments on the development of new quality measures for "meaningful use."
"I think HHS and its committees need to keep this comment in mind while they work on this project.
More quality measures means more data input from doctors and their staff. This is costly to doctors. CMS has already reduced our reimbursements over the years and is constantly threatening to reduce our reimbursements even more. If they keep this up and at the same time increase our workload (data input) and/or cause our overhead to increase due to having to hire more staff to input data for quality measures, CMS is going to find themselves without physicians to care for Medicare patients. If any Medicare physicians remain, they will have to divert their attention from patient care, what they are trained to do, what they do best and from what they went into medicine for, to data input. I can't see that this scenario is going to improve patient care. CMS, HHS, The HIT Policy Committee, the Quality Measures Workgroup and the ONC must realize that there is a point of diminishing returns for their demands for quality measures. More data doesn't necessarily equate to better patient care and in fact may cause patient care to deteriorate for reasons stated above. Also, reported measures may look better not because of better care but because of better and more clever reporting skills.”
Thanks,
Doug Duncan MD