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At this year’s Picis Exchange meeting in Miami, FL, I had a chance to sit down with Tommy G. Thompson, whose resume will take up half of this blog post – former secretary of Health & Human Services, four-term governor of Wisconsin, member of Picis’ board of directors and a personal friend and resource – to talk about where today’s healthcare system is headed.
The most compelling part of our discussion was his take on President Obama’s approach to healthcare reform and his direct advice on next steps.
Let us know if you agree or disagree with his advice – and what yours might be? And stay tuned for more from our discussion in the weeks ahead!
- Todd Cozzens
I don’t know about you, but I was thrilled to hear about today’s launch of MEDS-ED Link, a project of the Northern Virginia Regional Health Information Organization (NoVaRHIO) in conjunction with Inova Health System and GE Healthcare.
In a move that caught many by surprise, the recently-installed coalition government of Britain has proposed a radical reorganization of the National Health Service (NHS). The goals of the reorganization are to decentralize the control of the NHS budget, dismantle layers of bureaucracy, empower patients, and realize some £20 billion in savings through increased efficiency. All of this is set against a backdrop that calls for doing more with less – improving outcomes, ensuring high quality care and patient safety and giving providers and hospitals more autonomy while requiring more accountability. The UK, like much of Europe, is looking at ways to restructure budgets and social programs, in an attempt to reduce deficit spending and overall debt. And while the original goals of healthcare reform in the US included cost control, we on this side of the Atlantic did not take the courageous steps necessary to “bend the curve” on health care costs.
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.
Meaningful use was a major focus of many presentations at the recent Picis Exchange User Conference in Miami, but it was the representation from hospitals in Europe (including World Cup finalists Spain and the Netherlands!) and the UK, that sparked some of the most interesting discussions. It made me realize that European hospitals have been working to achieve many of the same “meaningful use” criteria that have become such a huge focus here in the U.S. – but that they have been doing it for much longer than ARRA HITECH has been around. From coordination of care to improving quality measures, Europeans have been in the “meaningful mindset” for a long time.
This blog was created to serve as a forum for the exchange of ideas, and we’ve loved the responses, reactions and dialogue it’s generated over the past several months. Yet for as much as we’ve all come to rely on the blogosphere for the latest and greatest in everything from kayaking to healthcare IT, this week’s Picis Exchange customer user conference in Miami Beach was a great reminder of the power and effectiveness of in-person collaboration and discussion.
Surrounded by health care enthusiasts from nearly 100 hospitals, integrated delivery networks, and government health systems from across six countries and 28 states, I’ve been saturated all week with the most innovative yet real-world ideas from the men and women who serve on the front lines of health care IT every day. Nurses, physicians, IT professionals and administrative staff have spent the past few days sharing stories about how they’re demonstrating meaningful use, moving towards health information exchanges and using evidence-based medicine to improve patient care, by utilizing the data and information they derive from our systems. Not only that, they’re also able to trade war stories and come up with solutions even we might not have thought of.
You may have heard the news yesterday that Allscripts has acquired Eclipsys. I weighed in on this move in an article that ran on HISTalk. You can find the article here, but I also wanted to share my thoughts here on the blog:
There is an increasing trend for general practitioners to be employed by hospitals, but an opposing trend that specialist areas like emergency and anesthesia are outsourcing physician services. So net/net, though on the surface it makes sense to combine the two areas, there is no real market force pushing for an end-to-end hospital-to-physician EHR. To the contrary, the one thing that really is taking off with lightning speed from ARRA is interoperability within and outside the hospital enterprise.
I can cite 10-15 real examples of systems already pushing CCDs among disparate EHRs, for example. Hospitals just aren’t in a position for wholesales swapouts of their IT systems across the board — it’s too disruptive and expensive. The new interoperability mandates will allow more modular approaches to building out EHRs.
A recent article in the Pittsburgh Tribune–Review speaks to a growing problem for hospitals: not getting paid for the complex medical care they provide. This is happening at an increasing and alarming degree as a result of insurance auditors determining that when a patient is admitted to the hospital from the emergency department (ED), “medical necessity was not met” – meaning the patient should have been treated under “Observation” status rather than “Admission” status. Federal regulations driving these audits speak to the growing need for proper medical necessity documentation at the time of “patient disposition” – when a physician decides whether a patient should go home, be admitted or held in observation. As a result, emergency doctor admissions are now closely scrutinized.
A maddening Medicare rule is responsible for this increasing incidence of post-payment audits and physician scrutiny. This rule, often enforced by Recovery Audit Contractors (RAC), is based in congressional law. The Medicare Modernization Act of 2003 established the RAC program to identify improper Medicare overpayments and underpayments, and RACs are paid on a contingency fee, receiving a percentage of the improper overpayments and underpayments collected from providers. From March 2005 to March 2008, a government demonstration project in several states found $993 million in overpayments. Hospitals were found liable for 94 percent of the total overpayments. Of the inpatient admissions, 40 percent were deemed medically unnecessary and an additional 35 percent were targeted due to incorrect coding. What does this mean for hospitals and physicians? Medical necessity is 100 percent determined by physician documentation.
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.
There’s no arguing that healthcare lags behind other industries when it comes to technology, but contrary to popular belief, physicians are not the ones holding it up. Healthcare IT vendors are as much of the problem as they are the solution.
The truth is that many healthcare software systems are overly complex, provide a clunky physician/EHR interface, and require a significant amount of time and effort to transform them into user-friendly tools that actually make physicians’ lives better. When doctors lack the time to master their department’s IT systems, they often turn to the use of scribes – typically hourly paid resources who step in for time-constrained doctors and input patient, clinical, and charge capture data into EMR systems on their behalf.
In some cases, hospitals use scribes to perform far more valuable duties than just data input – George Washington University created an educational program for pre-med college students and first year med students considering emergency medicine. In this case, scribes serve as “workflow facilitators,” where a small slice of time is spent entering physician documentation into an EMR, while also helping ED efficiency by helping track down labs/x-rays/consultants, prepare discharge paperwork and ease communication between staff and patients/families.
