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As an insider in healthcare for more than 20 years, today is an exciting day for me. Picis, the company I co-founded with Liz Popovich and helped grow into an international software company with 700 employees, is being acquired by Ingenix, a leading HIT, consulting and services company with nearly 6,000 hospital clients around the world.
This is a classic “win-win-win” situation that will benefit us, Ingenix, and all our customers and prospects. With all that is going on in healthcare industry today, I can tell you from the heart that the timing was perfect for this transaction, and this is truly the best possible home for Picis in which to grow and prosper.
One of the most important aspects of any emergency department (ED) is risk management. Unfortunately, with tort reform hot on everyone’s mind, many people associate risk management strictly with hospitals and physicians doing everything they can to “CYA” – translation, avoid malpractice lawsuits. But that couldn’t be further from the truth. With the passing of the healthcare reform bill, risk management will continue to play a critical role in supporting our nation’s physicians and the clinical decisions they need to make to ensure patients receive the best possible care.
The newly-insured are going to soon flood today’s already overcrowded EDs, and pressure on each individual physician is only going to continue to mount. For many ED clinicians, the day starts out with a worried look out onto a crowded waiting room – so many patients to see, with more to come. Whether they want to admit it or not, the fear that runs constantly through every physician’s mind is, “What if, in the chaos that surrounds me, I miss something?” Every physician will take every possible opportunity to ensure that they don’t. But of the dozens of patients in that waiting room, a handful of them likely have high-risk conditions, and no matter how skilled you are, the trouble is identifying them where you least expect it. Enter the support of risk management.
I was traveling through Europe during the last week of the healthcare debate, leading up to the House of Representative’s vote to pass the Senate’s version of healthcare reform. I found it quite interesting that both the European press and the “word on the street” seemed to indicate that most Europeans believed that the U.S. was “finally” going to catch up to them – that America was finally going to provide universal healthcare to all of the people in the U.S. You should have seen the surprise on those faces after I informed them that even the most optimistic estimates would still leave over 10 million people without health insurance (to put it in a European context…more than the entire population of Greece, or Belgium, or Austria). It was obvious that the average European impression of American-style health reform was a movement towards their norm. They failed to understand that this was less about healthcare, and much more about politics and winning elections.
When President Obama set out to pass healthcare reform legislation, he stated two specific reasons why this was so important: universal access to health insurance and cost control. In fact, he often spoke of how the spiraling costs of healthcare in the US threatened the very viability of our economy. The President said that we could not sit idly by and watch healthcare costs grow to consume 20 percent of our GDP. It was the reason why companies like GM could not compete against their foreign counterparts. Well, when you look at the Congressional Budget Office’s (CBO) projected outcomes of the legislation and the subsequent reconciliation bill that were just signed into law, there will still be 12 to 14 million Americans without health insurance 10 years from now, and the growth in healthcare expenditures will reach more than 20 percent of the GDP in 2020.
I’m very torn about healthcare reform. As a business owner smack dab at the epicenter of the effects of healthcare reform, it’s a very timely boon to our business. As a taxpayer, although I think a lot of the reforms are necessary, I’m very skeptical about how we go about implementing and paying for it. And in many ways, I think so much more could have been done.
Good for business, but good for patients?
For Picis, healthcare reform and its companion legislation, the ARRA HITECH stimulus money, are going to spur tremendous growth opportunities. Today, the 32 million people that will soon be insured will end up going to the hospital emergency room for care under the EMTALA law (where hospitals aren’t allowed to turn away ER patients). The only problem is the hospital ends up footing the bill, putting pressure on their margins and reducing their ability to invest capital in IT and other systems. After covering 4 million more lives here in Massachusetts, we actually saw ER visits go up by 7 percent. Why? We didn’t add any more primary care doctors, and these newly insured patients swelled the offices of the existing general practitioner population to the point where 56 percent are no longer taking new patients. So where do these patient go? You guessed it – back to the ER, but for an entirely different reason. They’re not going to the hospital to get the only free care they can get – they’ve now got insurance – they’re going because they can’t find a doctor to see them in the ambulatory setting.
HIMSS is always a great conference, but I have to admit – on my flight down to Atlanta, I was slightly dreading four days of endless hypotheses around meaningful use. The understandable theme of this year’s show, meaningful use, has quickly escalated from an exciting and game-changing initiative to one that has even the most optimistic healthcare enthusiasts scratching their heads and drowning in buzzwords, overpromising and under-delivering. It was only at last year’s HIMSS that one of the largest HIT vendors claimed they had meaningful use nailed down (only weeks after the announcement of the initiative) but when tested, couldn’t give a straight answer on what it meant or how it would deliver value to patients.
This year, however, I’m already noticing a reality running through HIMSS that I was pleased to find. This year’s sessions have revealed that a lot of attendees are more comfortable admitting the reality of the situation; that they are just now really understanding the challenges that this will bring. I overheard an IT executive from one of the most prestigious and well-regarded health centers in the world claim, “If we’re not sure that we are going to be ready by 2011, I can only imagine what others are facing.”
“In Stunning Upset, Brown Captures US Senate in Mass.”
“Scott Brown Roars to Senate Upset Win”
“G.O.P. Senate Victory Stuns Democrats”
Now that Scott Brown has been sworn in as the junior Senator from Massachusetts, I decided to revisit this story within the context of healthcare reform. As I re-read these headlines on Brown’s “upsetting” win over Attorney General Martha Coakley for the U.S. Senate seat a few weeks ago, I couldn’t help but wonder — “should we really have been that surprised?” In retrospect, let’s take a look at the evolution of the public sentiment specific to healthcare reform (stats courtesy of Gallup polling):
Welcome to the inaugural post of Healthcare-Exchange, a forum designed to offer fresh perspective, encourage the exchange of ideas and drive discussion — no matter how controversial — all in the name of healthcare.
A term that’s come to encompass so much more than a doctor’s visit, healthcare in the US has seen more changes over the past few years than in the 20 years before it. From the electronic health record to patient safety to universal coverage, we invite you to weigh in on the issues that will make the biggest impact on the healthcare world in the year ahead. Below, I’ve included my Top Five Predictions for 2010 and want to hear if you’re on the same page:
